1472 6947 12 67

Mosa et al.
BMC Medical Informatics and Decision Making 2012, 12:67

http://www.biomedcentral.com/1472-6947/12/67
RESEARCH ARTICLE Open Access
A Systematic Review of Healthcare Applications

for Smartphones
Abu Saleh Mohammad Mosa1, Illhoi Yoo1,2* and Lincoln Sheets1,3
Abstract
Background: Advanced mobile communications and portable computation are now combined in handheld
devices called “smartphones”, which are also capable of running third-party software. The number of smartphone
users is growing rapidly, including among healthcare professionals. The purpose of this study was to classify
smartphone-based healthcare technologies as discussed in academic literature according to their functionalities,
and summarize articles in each category.
Methods: In April 2011, MEDLINE was searched to identify articles that discussed the design, development,
evaluation, or use of smartphone-based software for healthcare professionals, medical or nursing students, or
patients. A total of 55 articles discussing 83 applications were selected for this study from 2,894 articles initially
obtained from the MEDLINE searches.
Results: A total of 83 applications were documented: 57 applications for healthcare professionals focusing on
disease diagnosis (21), drug reference (6), medical calculators (8), literature search (6), clinical communication (3),
Hospital Information System (HIS) client applications (4), medical training (2) and general healthcare applications (7);
11 applications for medical or nursing students focusing on medical education; and 15 applications for patients
focusing on disease management with chronic illness (6), ENT-related (4), fall-related (3), and two other conditions
(2). The disease diagnosis, drug reference, and medical calculator applications were reported as most useful by
healthcare professionals and medical or nursing students.
Conclusions: Many medical applications for smartphones have been developed and widely used by health
professionals and patients. The use of smartphones is getting more attention in healthcare day by day. Medical
applications make smartphones useful tools in the practice of evidence-based medicine at the point of care, in
addition to their use in mobile clinical communication. Also, smartphones can play a very important role in patient
education, disease self-management, and remote monitoring of patients.
Background the literature according to their functionalities and

Recent years have seen an increased adoption of smart- summarize them in each category. We present a system-
phones by healthcare professionals as well as the general atic literature review in this regard. To the best of our
public [1-6]. The smartphone is a new technology that knowledge, this study is the first study for classifying
combines mobile communication and computation in a and summarizing healthcare applications for smart-
handheld-sized device, facilitating mobile computing at phones in a systematic literature review format.
the point of care. The main objective of this study is to The healthcare system is highly mobile in nature, involv-
classify the smartphone-based healthcare technologies in ing multiple clinical locations such as clinics, inpatient
wards, outpatient services, emergency departments, oper-
ating theaters, intensive care units (ICUs), laboratories,
* Correspondence: yooil@health.missouri.edu
1
University of Missouri Informatics Institute (MUII), 241 Engineering Building etc. [7-10]. As such, working in the healthcare system
West, Columbia, MO 65211, USA requires extensive mobility of healthcare professionals as
2
Health Management and Informatics (HMI) Department, University of well as communication and collaboration among different
Missouri School of Medicine, CS&E Bldg. DC006.00, Columbia, MO 65212,
USA individuals, including their colleagues and patients.
Full list of author information is available at the end of the article Healthcare professionals mainly used pagers for mobile
© 2012 Mosa et al. licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.
Mosa et al. BMC Medical Informatics and Decision Making 2012, 12:67 Page 2 of 31
communication until the wide availability of cell phones in provided through stationary computers, which does not
1990s [11]. The advent of mobile Personal Digital Assis- fully support the mobile nature of healthcare. In re-
tants (PDAs) during 1990s enabled healthcare profes- sponse, additional portable and wireless mobile informa-
sionals to organize their contacts and calendars tion communication technologies (MICTs) such as
electronically, adding another device in their pockets. The Computers on Wheels (COWs) or Workstations on
combined functionality of a pager, a cell phone and a PDA Wheels (WOWs) are used in some healthcare setup to
is now replaced by a single device called a “smartphone”, further facilitate access to information technologies at
which is becoming very popular among healthcare profes- the point of care [13]. The increased adoption of smart-
sionals as well as the general public [12]. Further details phones by healthcare professionals demonstrates the op-
on smartphones and their operating-system platforms are portunity for improved clinical communication, and
discussed in Appendix I. Table 1 in Appendix I illustrates access to information systems and clinical tools at the
an overview of OS features of smartphone platforms and point of care, or from anywhere at anytime [11,13-26].
Table 2 in Appendix I illustrates the support of common Accordingly, many software applications have been pro-
features by smartphone OS platforms with the availability duced for healthcare professionals in order to facilitate
of hardware in the device. the practice of evidence-based medicine (EBM) at the
A systematic review summarizing 23 surveys on PDA point of care.
usage by healthcare professionals (conducted in the U.S. The main stakeholders in the healthcare process are
(16 surveys), Canada (4 surveys), Australia (1 survey), healthcare consumers (patients). Consumer-oriented
both the U.S. and Puerto Rico (1 survey), and both the care, where patients are directly involved in the process
U.S. and Canada (1 survey) between 2000 and 2005) of care, will greatly improve the healthcare process.
demonstrated that overall adoption rate varied between Technology can play key roles in consumer-oriented
45% and 85% in 2004–2005 [1]. The patterns of PDA healthcare (for example, making information accessible
usage reported by this study [1] were: (1) younger physi- to consumers, integrating consumers’ preferences into
cians (94%) were more likely than older physicians HISs, remote monitoring, communication, etc.), which is
(84.5%) to use a PDA, and students and medical resi- studied in a branch of medical informatics called Con-
dents tended to be younger and were more likely to use sumer Health Informatics (CHI) [27]. The management
a PDA; (2) no significant gender difference in PDA users of diseases with chronic conditions is very costly. For ex-
was reported among physicians, internists or residents; ample, the report published in the 2011 National Dia-
(3) the biggest adopters of PDAs were family and general betes Fact Sheet by the Centers for Disease Control and
practitioners; (4) large-practice and hospital-based physi- Prevention (CDCP) of the U.S. Department of Health
cians were higher adopters of PDAs than office-based and Human Services demonstrated that about 25.8 mil-
physicians; and (5) PDA use was more likely among lion people in the U.S. (8.3% of population) have dia-
urban physicians than rural physicians. According to re- betes and the estimated national cost (direct and
search conducted by Manhattan Research in 2009 on indirect) of diabetes was 174 million dollars in 2007
the professional use of smartphones by physicians, about [28]. Self-management and remote monitoring of
64% of the physicians in the U.S. used smartphones in patients are becoming viable solutions for management
2009 compared to only 30% in 2001. This report found a of diseases with chronic conditions, and smartphones
noticeable increase in smartphone adoption and pre- are playing very important role [29-35]. Clinician-led pa-
dicted that 81% of physicians would use smartphone in tient education in disease prevention and management
the U.S. by 2012 [2]. through smartphones and text-messaging is convenient
During recent years, healthcare professionals have and effective [36,37]. A study performed by comScore
required access to many technologies at the point of demonstrated an increase of 27.7 million smartphone
care, such as: (1) Hospital Information Systems (HISs) users (from 49.1 million at the end of May 2010 to 76.8
including Electronic Health Record (EHR) or Electronic million at the end of May 2011) in the U.S. [4,5]. We
Medical Record (EMR) systems, Clinical Decision Sup- discuss 6 major operating systems (OS) for smartphones
port Systems (CDSSs), Picture Archiving and Com- and their current market share and worldwide market
munication Systems (PACSs), Laboratory Information share forecasts for 2015, and compare their features in
Systems (LISs), etc.; (2) evidence-based resources such Table 1 and Table 2 in Appendix I.
as PubMed and Up-to-Date; (3) clinical applications
such as medical calculators, drug databases, and disease Methods
diagnosis applications; and (4) clinical communication Data Sources
such as voice calling, video conferencing, text messaging, In this study, we present a systematic literature review
and email messaging. Access to information systems or of healthcare applications for smartphones following
clinical applications in healthcare settings is mainly the PRISMA statement for systematic reviews [38].
MEDLINE citations were searched in April 2011, using In addition, we accessed the websites of the applications to
the PubMed search engine, for articles that discuss the get the latest release information (last access in June 2011).
design, development, evaluation, or use of smartphone
software applications to be used by healthcare profes- Results
sionals or patients. The MeSH vocabulary, which is The flow diagram of identifying eligible articles for this
used to index MEDLINE articles, does not contain study is shown in Figure 1. The literature searches
“smartphone”. However, since smartphones are the resulted in a total of 2,894 articles, which were then ini-
successors of PDAs and handheld computers, the tially screened based on the titles and abstracts. The in-
MeSH term "computers, handheld" was used in MED- clusion and exclusion criteria, described in the previous
LINE to index the articles with a focus on smart- section, were followed in the screening process resulting
phones. In this study, the search terms used for in the exclusion of 2,780 articles. The remaining 114
eligible articles were: (1) "computers, handheld"[MeSH articles were then reviewed in full text, and an additional
Terms], or ("computer$"[All Fields] and "handheld"[All 59 articles were excluded because they did not primarily
Fields]), or "handheld computer$"[All Fields]; or (2) discuss smartphone applications but used smartphones
"smartphone$"[All Fields], or "smart-phone$"[All for other purposes. One article was excluded because it
Fields], or "smart phone$"[All Fields], or "iPhone"[All was not written in English. The resulting 55 articles, dis-
Fields], or "Android"[All Fields], or "blackberry"[All cussing 83 smartphone-based healthcare applications,
Fields], or "black berry"[All Fields], or "Windows met the eligibility criteria. The earliest eligible articles
Mobile"[All Fields] or "Windows Phone"[All Fields]. were published in 2003, and 24 of the 55 articles were
The search terms only focused on the terms synonym- published in 2010 through April 2011.
ously to the term “smartphone.” The search criteria The applications were grouped by the targeted user of
did not include any limitation on publication date, and the applications, as divided into three groups: (1) health-
the earliest eligible article was published in 2003. The care professionals, (2) medical or nursing students, and
reference lists of included articles were also searched (3) patients.
systematically.
Application for Healthcare Professionals
Inclusion and Exclusion Criteria There are many smartphone-based applications for
This study mainly focused on the functionality of soft- healthcare professionals. In this study, a total of 57
ware for smartphones within the scope of healthcare. As applications for healthcare professionals were identified
such, the inclusion criteria for the articles were the de- from 43 eligible articles. These applications were
sign, development, evaluation or use of smartphone- grouped into 7 categories based on functional similarity:
based applications for healthcare. As the search terms disease diagnosis, drug reference, medical calculators, lit-
only focused on the terms synonymously related to the erature search, clinical communication, HIS clients, and
term “smartphone” and included the MeSH term "com- medical training. Some applications did not fall into any
puters, handheld"[MeSH Terms], the search result of those categories and were discussed in the section
included many articles that have no focus on application titled “general healthcare applications”.
programs of smartphones but used smartphones for
other purposes, or used handheld computer devices than Disease Diagnosis Applications
smartphones or their predecessors, PDAs. Those articles Disease diagnosis applications were designed to access
were excluded from this study. This study also excluded diagnosis and treatment information in a few taps on a
articles that were not published in English. In short, we smartphone. A total of 21 disease diagnosis applications
adopted a recall-focused retrieval strategy not to miss were discussed in 16 articles. Table 3 in Appendix II
relevant documents in the MEDLINE. Irrelevant docu- provides detailed information about the 21 applications.
ments by the strategy are excluded manually. Of these, eight articles mainly focused on the overview
and uses of applications [11,17,23,26,39-42], four articles
Study Selection and Data Extraction published surveys on the use of the applications [16,43-45],
The titles and abstracts of the identified citations were two articles compared the applications in terms of
read to screen the articles based on the selection criteria treatment recommendations [46,47], and two articles
described in the previous section. The remaining articles investigated the application of smartphones to diagnosis
were read in full text to extract information from each and treatment [48,49].
article. The extracted information is presented in tables Handheld versions of printed medical references for
(Tables 3, 4, 5, 6, 7, 8, 9, 10, 11 and 12) including smart- disease diagnosis were available on smartphones, provid-
phone application names, supported operating system plat- ing information on infectious diseases, pathogens, diag-
forms, descriptions and functionalities of the applications. nosis, treatment, medications, differential diagnosis etc.
Figure 1 Trial Flow Diagram. This figure presents the trial flow diagram of identifying eligible articles for this study. A total of 2,894 articles were
returned from the literature searches. Initially, a total of 2,780 articles were screened based on their titles and abstracts satisfying the inclusion and
exclusion criteria. An additional 59 articles were excluded after full text review of 114 articles. Finally, 55 articles discussing 83 smartphone-based
healthcare applications met the eligibility criteria. The earliest eligible articles were published in 2003, and 24 of the 55 articles were published in
2010 through April 2011.
There are eight of these applications including Johns treatment recommendations in every case, JHABx in
Hopkins Antibiotic Guide (JHABx), 5-Minute Clinical 99% of cases, 5MCC in 97%, 5MID in 95%, and PMID in
Consult (5MCC), 5-Minute Infectious Diseases Consult 52% [46]. The treatment recommendations of four appli-
(5MIDC), Sanford Guide to Antimicrobial Therapy (SG), cations, ePocrates ID, JHABx, 2002 SG, and ID Notes,
ePocrates ID, Infectious Disease Notes (ID Notes), were compared with current practice guidelines by
Pocket Medicine Infectious Diseases (PMID), and IDdx. Miller et al. (2003) [47], who concluded that JHABx is
These applications also provide internal links for easy highly preferable for its inclusion of more details, accur-
navigation and searching. ate treatment and diagnosis information, and an auto-
A 2004 study evaluated SG, JHABx, 5MIDC, 5MCC, matic update process. A survey study reported that
PMID, and ePocrates ID for treatment recommendations nurse practitioners ranked medical text and reference
on 202 cases and reported that five of the applications books as the second most useful category of PDA appli-
provided treatment recommendations in more than 95% cations, and 14% of responders specifically mentioned
cases. Specifically, SG and ePocrates ID provided 5MCC as very useful [43].
UpToDate is an evidence-based clinical smartphone tool and body positions that is the primary treatment of Be-
that provides the most recent clinical evidence and nign Paroxysmal Positional Vertigo [41]. Mezzana et al.
includes more than 9,000 physicians’ topics, 5,000 drug (2011) [49] used the Video Laser Level application in
topics, practice change updates, etc. This application is oculoplastic surgery by superimposing two digital hori-
very useful in the practice of EBM at the bedside [40] and zontal lines onto a real image to show canthal ligament
is very useful for the integration of test results with clinical misalignment. Joundi et al. (2011) [48] measured tremor
information [17]. In a community hospital, internal medi- frequency using the iPhone iSeismometer application
cine residents reported UpToDate as their most com- and found that it matched the more sophisticated and
monly used evidence-based resource and about 50% of expensive EMG analysis.
them reported using it for general medical and scientific Smartphone-based disease diagnosis applications are
information as well as specific questions on patient man- useful evidence-based resources at the bedside. These
agement [45]. Phua & Lim (2008) [16] conducted a survey applications can also help clinicians in identifying appro-
on the use of evidence-based resources by residents in a priate laboratory tests based on symptoms, decreasing
tertiary care hospital in Singapore with an institutional unnecessary tests and reducing cost of care. Radiology
subscription to UpToDate. They found that only 69.4% of tests, for example, are very expensive and unnecessary
the residents were aware of their institutional subscription, tests are undesirable; but clinicians can use the “eRoent-
so the actual use of UpToDate was low (56.7%). However, gen Radiology Dx” application on their smartphones to
most of the users (93.4%) found it useful and would rec- identify the most appropriate radiology exams for
ommend UpToDate to their colleagues, and for about patients, reducing the cost of care and improving patient
three-fifth of them using UpToDate led to changes in safety [23]. Other applications use clinical algorithms to
patient-management decisions [16]. One of our authors help clinicians understand and apply principles of dis-
(LS), a practicing physician, has observed that his collea- ease diagnosis. The flowcharts included in 5MCC and
gues in U.S. private and academic practice consult UpTo- Pocket Guide to Diagnostic Tests, for example, can help
Date far more often than any other single resource at the physicians see at a glance diagnostic possibilities that
point of care, and that it seldom fails to return fast, fo- they may have overlooked.
cused, and practical results.
There were six applications providing common labora- Drug Reference Applications
tory test information, including reference values and inter- A total of six drug reference applications were discussed
pretation, causes for abnormal (increased or decreased) in the eight articles. Table 4 in Appendix II provides
values, and laboratory unit conversions. These were Palm detailed information about the drug reference applica-
LabDX, Normal Lab Values, Lab Unit Converter, Labs tions. Six of these articles mainly focused on the
360o, Davis’s Laboratory and Diagnostic Tests, and Pocket overview and use of the applications [11,39,40,50-52],
Guide to Diagnostic Tests [17,26,44]. Palm LabDX was and two articles published surveys on use of the appli-
evaluated by third-year medical students in their internal cations [43,53]. The six applications are: Skyscape’s
medicine clerkships, mostly during patient care activities, RxDrugs, Epocrates, Medscape, SafeMed Pocket, FDA
and found to be useful [44]. Lippi & Plebani (2011) [26] drugs, and DrugDoses.net. The drug reference applica-
emphasized the formal review process of the laboratory tions generally include the names of drugs, their indica-
applications in strict compliance with laboratory medicine tions, dosages, pharmacology, drug-drug interactions,
professional bodies such as the International Federation of contraindications, cost, and identifying characteristics.
Clinical Chemistry and Laboratory Medicine (IFCC). Epocrates was cited as the most commonly accessed
Smartphones can also be applied in the process of drug-reference application [11,50,51]. Epocrates and
diagnosis and treatment using software application. A Skyscape’s RxDrugs, another drug reference that our
simple smartphone application for eye-care professionals physician author has seen widely used in the U.S., can
is a visual acuity test. For example, EyeChart is an check multiple drug-drug interaction at the same time
iPhone application that includes the Snellen eye chart to [11]. FDA Drugs, which includes package inserts or offi-
measure visual acuity [41]. A similar application is Eye- cial labels of FDA-approved prescription and over-the-
Phone, which includes a distance E-test, near visual acu- counter drugs, shares this functionality and also searches
ity test, color test, Amsler grid, and pupil gauge test by active ingredients [39]. SafeMed Pocket, which was
[42]. Our physician author, who frequently practices in designed to be used in Sweden and lists drugs that are
low-resource clinical settings, has found that having licensed for sale in that country, is integrated with a
convenient access to a Snellen chart is indispensable al- clinical decision support system (CDSS) for use by geria-
though its use is limited to patients that are literate in tiric homecare nurses to warn of drug-drug interactions,
the Roman alphabet. The DizzyFIX application guides therapeutic duplications, and dosages that are unsuitable
clinicians in the Epley Maneuver, a series of precise head for elderly people [52].
Smartphone-based drug reference applications can be based on their age in years [41]. Drug dosages for
useful evidence-based resources at the point of care, as patients with renal failure can be calculated by Soft-
Richardson & Burdette (2003) [40] show in their ex- force’s Antibiotic Dosage Calculator. The uBurn app
ample of using Epocarates in the practice of evidence- helps surgeons to calculate the percentage of total body
based medicine during hospital rounds. A survey of surface area affected in adult burn victims [56].
PDA usage by nurse practitioners reported that drug
reference applications were the most useful of all appli- Literature Search Applications
cations, and that 92% of the PDA users surveyed used Literature search applications for healthcare professionals
Epocrates [43]. Another survey of PDA usage by under- facilitate searching biomedical literature databases such as
graduate medical students at the University of Alberta, PubMed/MEDLINE, Essie, etc. to find and display medical
Canada reported that 77.4% of students used drug refer- reference information. The experience of our physician
ence applications, making them the most commonly author is that these resources are seldom useful at the
used medical application in that population [53]. point of care and seldom used by clinicians in that setting.
However, our review found six literature search applica-
Medical Calculator Applications tions discussed in 15 articles [41,42,45,50,51,55-64]. Table
A medical calculator or clinical calculator is a software 6 in Appendix II presents the functions of these six appli-
program for calculating various clinical scores and indi- cations, PubSearch, PubMed on Tap, MEDLINE Database
ces such as body mass index (BMI), body surface area on Tap (MD on Tap or MDoT), askMEDLINE, PICO, and
(BSA), coronary heart disease risk, individual drug dos- Disease Associations.
ing, etc. Usually calculation of clinical scores or indices The free PubSearch [51] and fee-base PubMed on Tap
involves complex formulas using several input para- [41,42,56] are two commercial applications for the iOS
meters. Medical calculators typically provide a user platform that facilitate PubMed/MEDLINE search from
interface to enter parameters and calculate scores using iPhone. These two applications are client applications
a standard formula. Users do not need to use or even for PubMed/MEDLINE. The National Library of Medi-
know the actual formula for calculating a clinical score cine (NLM) provided MD on Tap (MDoT) to help
or index. For example, body mass index or BMI (also healthcare professionals find answers to clinical ques-
known as the Quetelet Index for its creator, Belgium sta- tions and access medical reference information at the
tistician Adolphe Quetelet, 1796–1874), is the most point of care through three search engines: PubMed,
commonly used measure of obesity internationally [54]. Essie, and Google [58]. In some articles [57,58], the
weight ðkg Þ NLM’s MDoT project was referred as “PubMed on Tap”
Our physician author has found that the ðheight ðmÞÞ2
or
weight ðlbÞ703 since it was initially named as “PubMed on Tap”, which
ðheight ðinÞÞ2
formula for calculating BMI, while simple to is different than the “PubMed on Tap” for iPhone men-
remember, is surprisingly time consuming and error- tioned at the beginning of this paragraph. MDoT is a cli-
prone in the time-pressured environment of a busy ent–server application in which the software client
clinic. The user only needs to enter a patient’s weight (available for Palm OS and Windows Mobile platform)
and height in a typical medical calculator, however, to sends the user’s plain-text query to the intermediate ser-
calculate the BMI quickly and confidently. ver (called MD on Tap server), which formats the query
Initially, medical calculator software programs were into appropriate search terms for the selected search en-
available on personal computers. Later, online versions gine (Essie, PubMed/MEDLINE, or Google) and returns
of some calculators were accessible through the Internet. the search results to the client application [58]. The
However, physicians were often unable to use this soft- search result is then displayed by grouping the articles
ware at the point of care due to a lack of computer ac- into several clusters. The performance of MDoT in
cess. Now medical calculators are available for several answering clinical question varies with the selection of
smartphone platforms. Table 5 in Appendix II presents search engine. Studies showed that Essie performed bet-
eight smartphone-based medical calculator applications ter than PubMed/MEDLINE [59,64]. However, later
that were discussed in 10 articles [11,16,26,39,41- studies showed that medical residents using PubMed/
43,47,55,56]. These eight applications are: Epocrates MEDLINE on MDoT during daily rounds answered
MedMath, MedCalc, Medical Calculator, Calculate, most of their clinical questions (68% and 86% in two
Archimedes, uBurn Lite, Softforce’s Antibiotic Dosage separate studies) when queries consisted of three or
Calculator, and Paeds ED. The most commonly used more medical terms [63,64].
medical calculators are MedMath and MedCalc [11,43]. The MDoT client application required improvement in
The calculation of drug doses for pediatric patients is navigational and functional characteristics such as in-
very crucial during medical emergencies, and the “Paeds corporating visual cues to indicate a visited citation [57].
ED” application calculates drug dosages for children The requirement of maintaining a high performance
server for hundreds of concurrent users is a disadvan- communications that receives monitor data, alarms,
tage for MDoT compared to client-only literature search ECGs, and lab results on smartphones.
applications like PubSearch or PubMed on Tap, since The use of mobile phone communication in critical
the search engines for these latter are already deployed care environments facilitates relaying important infor-
in high performance servers and maintained by the pro- mation quickly, reducing the risk of medical errors [66].
viders. MDoT’s advantage is that the user interface was Nurses may need to go through a complex process to
implemented independently while the processing power find the responsible physician for a patient using trad-
was delegated to the server and all transactions are itional numeric paging. In Toronto General Hospital, the
stored in a local database on the server, facilitating re- use of smartphones simplifies reaching the responsible
search on users’ queries from mobile devices [58,64]. In physician. Nurses can send email messages indicating
2007, the development and support for MDoT client priority and requesting feedback if necessary, or can call
application was stopped, introducing compatibility issues directly in emergency cases [12]. However, mobile com-
with future operating system versions [65]. munication may impact informal group discussions
Search results mainly depend on the query’s precision, among workers in the common areas that support some
so experienced users use specialized vocabulary such as important activities such as managing schedule changes,
MeSH to find relevant citations in PubMed/MEDLINE. and discussions related to professional feedback and
The “PubMed for Handhelds” site (http://pubmedhh. quality control. This impact in a surgical department
nlm.nih.gov/) provides access to the PICO (Patient, was found to be negative and additional socio-technical
Intervention, Comparison and Outcome), askMEDLINE, mechanisms may be required to overcome this [67].
and Disease Associations (DA) search engines, devel-
oped by the NLM to facilitate literature search without HIS Client Applications
knowing MeSH. PICO facilitates well-formatted search Client applications for Hospital Information Systems
that includes four text fields: problem, intervention, (HISs), such as electronic health records (EHR), elec-
compare to, and outcome [45,60,62]. The askMEDLINE tronic medical records (EMR), and picture archiving and
search engine was developed from PICO to allow natural communication systems (PACS), provide the flexibility
language query [45,60-62]. DA is a search interface for of accessing patient information securely from anywhere
case reports and review of reported cases in PubMed/ at any time. A total of five articles discussed the use of
MEDLINE [45]. smartphones to access patients’ clinical information
[20,22,23,51,68]. Table 8 in Appendix II provides detailed
Clinical Communication Applications information about HIS client applications for smart-
Smartphones support several means of communication phones. These applications provide some of the func-
including voice calling, video calling, text messaging, tionality of their PC counterparts. OsiriX Mobile is the
email messaging, multimedia (text, image, and video) client application for OsiriX PACS, which processes and
messaging, and conferencing through the cellular phone displays images using the DICOM standard for digital
service provider. Besides standard communications, clin- image storage [22,23,51,68]. MEDITECH, a client appli-
ical communication applications are designed to simplify cation for MEDITECH EMR, and PatientKeeper Mobile
communication among clinicians within a hospital. A Clinical Results, a client application for PatientKeeper
total of five articles discussing clinical communication EMR, provide access to patients’ clinical information from
using smartphones were included in this study a hospital EMR including lab results, medication lists,
[12,20,51,66,67]. Among them two articles discussed clinical notes, problem lists, vital signs, and allergies [20].
three smartphone-based communication applications AirStrip OB is designed for obstetricians to access their
[20,51], and three articles demonstrated the impact and EMR’s real-time and historical waveforms, fetal strips and
improvement in clinical communication using smart- maternal contraction patterns.
phones [12,66,67].
Table 7 in Appendix II shows the functionality of three Medical Training Applications
clinical communication applications that were discussed Smartphones are also used for medical training and con-
in two articles [20,51]. These three applications are tinuing medical education (CME). CME provides training
Voalté One, Amcom Mobile Connect, and mVisum; all in the most current evidence-based medical practice [69].
require the installation of proprietary communication A total of four articles discussed the use of smartphones in
servers. Voalté One combines phone calls, text messa- medical training [25,69-71]. Among them, one article dis-
ging, and alarm alerts into one device. Amcom Mobile cussed smartphone-based HIV/AIDS CME materials [25],
Connect is a messaging and alerting application that another article evaluated print and smartphone-based
separates critical messages from less important one. CME for men’s sexual health, and the other two articles
mVisum is a specialized application for cardiology discussed two smartphone-based software applications for
medical training. These two applications are listed in Table Hazardous Substances Data Bank (HSDB), and radio-
9 in Appendix II: iCPR and iResus. Both of the applications logical and biological substance reports [74].
are designed for the iOS platform and available for free. In homecare, nurses visit patients’ homes and may be
iCPR is a self-directed Cardiopulmonary Resuscitation isolated from the healthcare center. Borboleta, a
(CPR) training application that is based on both American smartphone-based mobile telehealth system, was devel-
Heart Association and European Resuscitation Council oped in Brazil for nurses in primary healthcare to use
guidelines. This application measures the chest compres- during patient homecare visits. The nurses can complete
sion rate and gives audiovisual feedback, improving the the patient registration and schedule a visit on their
performance of chest compression by helping the user to smartphones instead of using paper and pencil, and the
achieve the correct chest compression rate [71]. The data is centrally stored in a web server. In addition, the
United Kingdom’s resuscitation guidelines including adult nurses can access patient data, caregiver information,
and pediatric algorithms are visualized in an interactive socioeconomic data, visit history, disease history, and
format in the iResus application. The use of iResus signifi- medication history during homecare visits [73]. LIFe-
cantly improved the performance of certified advanced life reader, a CDSS system for nurses in geriatric homecare in
support clinicians [70]. Both iCPR and iResus were evalu- Sweden, was implemented to help nurses to obtain
ated in simulated clinical scenarios and further studies are patients medication profiles by scanning the European
required in real clinical settings [70,71]. Article Number (EAN) on the drug package. As described
Smartphone-based HIV/AIDS CME materials, includ- in the section tittled “Drug Reference Applications”, it can
ing 3D learning scenarios simulating interactive clinical also check for inappropriate drugs, drug-drug interactions,
cases, were provided to the clinicians in urban and peri- and therapeutic duplication. LIFe-reader reduces the
urban clinics in Peru. This software, while not commer- drug-related risks of falling and drug-related admissions
cially available, gave flexibility to the mobile health care to hospitals [52].
workers in accessing learning content in a resource-
limited setting [25]. However, another study [69] showed Applications for Medical and Nursing Students
no significant difference in evidence-based clinical There are many smartphone-based applications contain-
choices between users of printed vs. electronic CME ing primarily as educational material for medical or
modules on men’s sexual health. nursing students. Seven articles discuss a total of eleven
applications [11,17,23,41,47,51,56]. Table 11 in Appendix
General Healthcare Applications II lists the eleven applications and provides detailed infor-
Seven smartphone-based applications were categorized mation for each. They are I-Surgery Notebook, Eponyms,
as general healthcare applications, as they do not fit any Netter’s Atlas of Human Anatomy, Netter’s Anatomy Flash
of the categories discussed in the previous sections. Cards, Blausen Ear Atlas, Oxford Handbook of Clinical
These seven applications are HCSIT, Borboleta, LIFe- Specialties, Dissection, Cranial Nerves, iSilo, Mobipocket
reader, Multimedia Paging Based Clinical Alarm, Out- Reader, and Instant ECG.
breaks Near Me, H1N1 Swine Flu Update, and WISER. The anatomy tools for students are very useful, and
These applications were discussed in six articles our physician author found the flash-card application to
[39,52,72-75]. Table 10 in Appendix II shows detailed in- be a particularly good way to study during spare
formation about these applications. moments in medical school when books were not avail-
The Handheld Computer Smoking Intervention Tool able. Netter’s Atlas of Human Anatomy contains more
(HCSIT) assists clinicians with smoking cessation counsel- than 532 colored anatomic illustrations that are mainly
ing and improved physicians’ comfort level significantly in designed for educational purpose [23,56] and its Netter’s
counseling patients about smoking cessation [72]. A real- Anatomy Flash Cards version contains 300 interactive
time clinical alarm monitoring system was developed by flash cards [51,56]. Dissection is an anatomy tool that
van Ettinger et al. (2010) [75] to monitor intensive care displays dissection of the human head and neck [41]. A
unit patients by smartphone, displaying the alarms for an set of ear-related video animations including cochlear
entire unit or one bed, with the vital signs at the moment implants, ear pressure, ear tubes, hearing loss, hearing
of the alarm color-coded by severity. Outbreak Near Me tests, and otitis media are available in the Blausen Ear
provides real-time disease outbreak information and Atlas [41]. Cranial Nerves is a learning tool that includes
H1N1 Swine Flu Update provides a news feed for Swine interactive visualization along with textual information
Flu (H1N1) outbreaks [39]. H1N1 Swine Flu Update is about cranial nerves and the skull base, based on high-
now discontinued since the H1N1 pandemic has abated. resolution CT scans [41]. Instant ECG is a basic ECG tu-
WISER is an application for Emergency Medical Service torial application that includes ECG electrophysiology,
Specialists that identifies chemical and biological hazards myocardial action potential, associated waveforms, and
on the basis of symptoms and signs from NLM’s intervals and segments [23].
The details of eponymous signs and diseases are avail- patient data is sent from a smartphone through a General
able on smartphone through the Eponyms application Packet Radio Service (GPRS) connection to a medical staff
[51]. Students as well as surgeons, surgical interns, and computer and stored there to facilitate further tele-
residents can use I-Surgery Notebook on their iPhone or consultation. The Diabeo telemedicine system reduces the
Android phone during their surgical sessions to log surgi- cost of care and improves metabolic control for diabetes
cal cases including procedure, pre-operative and post- patients [32].
operative diagnosis, list of involved surgeons, and type of Cardiomobile is a real-time remote monitoring system
anesthesia used [51]. The printed version of the Oxford for exercise-based cardiac rehabilitation that is com-
handbook of Clinical Specialties, which includes 12 books, prised of a heart and activity monitor, single lead ECG,
is available as handheld version on smartphones [41]. GPS receiver, and programmed smartphone (i-Mate SP3,
Several other medical books are available as electronic Dubai). The GPS receiver and monitor connect to a
version through electronic book reader application on smartphone via Bluetooth. The smartphone sends ECG
smartphone such as iSilo and Mobipocket Reader. iSilo rate, walking speed, heart rate, elapsed distance, and pa-
is a fee-based program that stores text in a highly com- tient location to a secure server for real-time monitoring
pressed format and facilitates text search within a docu- by a qualified exercise scientist. The system supports
ment or set of documents [17,47]. Mobipocket Reader is cardiac patients who are unable to access hospital-based
available for free and includes a library of all eBooks rehabilitation due to excessive travel time or lack of
stored in local media, with the ability to annotate, high- available programs in their area [35].
light, or bookmark any part of the eBook, and lookup Pulmonary Rehabilitation is an application for chronic
any word in several dictionaries [11]. obstructive pulmonary disease (COPD) rehabilitation
Smartphone-based healthcare applications for clinicians, and self-management, developed for smartphones by
discussed in the section titled “Application for Healthcare Marshall et al. (2008) [29], using a Bluetooth pulse ox-
Professionals”, can also be used by medical or nursing stu- imeter to measure the heart rate during exercise.
dents for educational purposes. For example, Cibulka & Patients can follow the step-by-step exercise instructions
Crane-Wider (2010) [76] designed teaching strategies for on their smartphones displaying patient heart rate, exer-
nursing students using smartphones that includeed a clin- cise time remaining in seconds, and feedback color
ical consult guide, a prescribing reference, and a differen- (green: normal physical condition, amber: normal condi-
tial diagnosis tool from Skyscape or Epocrates. The tion but near acceptable limits, red: dangerous physical
students used the software packages during their classes condition). No assessment or clinical evaluation of this
to access clinically relevant information and found very application was reported [29].
useful. In a systematic review by Kho et al. (2006) [77], The measurement of physical activity level (PAL) is
medical calculators and drug reference applications were important in many chronic diseases. The PAL Calculator
also found to be very useful in medical education. application uses smartphone questionnaires to calculate
PAL. Study results demonstrated a high accuracy from
Applications for Patients this method in comparison to reference values [82].
Fourteen articles discuss fifteen smartphone-based patient Ryan et al. (2005) [79] described an observational
oriented applications [23,29,32,35,41,78-86]. Table 12 study on asthma peak-flow monitoring using an elec-
in Appendix II shows detailed information about these tronic peak-flow meter connected to a smartphone. The
applications. There are six applications for manage- application sends peak-flow readings through the GPRS
ment of chronic conditions: Diabeo, Cardiomobile, network to a secure server, and receives asthma trend
Pulmonary Rehabilitation, PAL Calculator, Asthma analysis feedback from the server. The study demon-
Peak Flow Monitoring, and eCAALYX; four ENT- strated a satisfactory primary outcome measure [79].
related applications including Hearing Check, uHear, eCAALYX is a remote monitoring system for elderly
iTinnitus, and Sleep Aid; three applications for human patients with multiple chronic conditions presented by
fall detection including Fall Detector by Hansen et al. Boulos et al. (2011) [83] that receives data from wearable
(2005) [78], Fall Detector by Zhang et al. (2006) [80], health sensors in a smart garment, transmits data to the
and iFall; and two others: Purdue Momentary Assessment monitoring server, and identifies higher-level informa-
Tool, and Mayo Clinic Meditation. tion such as tachycardia and signs of respiratory infec-
Chronic disease management applications provide ex- tions based on established medical knowledge. Users can
pert feedback to patients based on their input. The Diabeo see current medical reports on their smartphones based
system helps diabetic patients by calculating bolus insulin on sensor data, perform new measurements, and com-
dose based on carbohydrate intake, pre-meal blood glu- municate with caregivers through the application [83].
cose, and anticipated physical activity reported; and auto- Hearing Check and uHear are two free hearing loss
matically adjusts carbohydrate ratio and basal insulin. The self-assessment tests for iPhone. Hearing Check was
developed by the UK Royal National Institute for Deaf sent to the server for further analysis. This has been
People (RNID), and calls a landline number to receive a shown to be an effective method for fall detection [80].
free hearing check [86]. uHear includes three assessment Sposaro and Tyson (2009) [81] demonstrated the cost-
tests: hearing sensitivity, speech in noise, and a question- effectiveness of iFall, which utilizes the inbuilt tri-axial
naire about common listening situations [41]. In accelerometer of an Android phone, processes the data
addition to its use as a self-testing device, our physician on the phone, and prompts the user in cases of possible
author has used uHear in low-resource clinical environ- falls. If the fall is confirmed by the user not responding
ments where complete audiometry was not available. to the application, iFall makes an emergency call [81].
iTinnitus is a sound-therapy application for patient with The Purdue Momentary Assessment Tool (PMAT) is a
tinnitus, which records tinnitus by frequency in Hertz human behavior monitoring tool using smartphones to fa-
and keeps track of the tinnitus in a daily diary graph. cilitate event-driven study design [87]. PMAT was success-
iTinnitus supports full masking therapy with a sound fully used to monitor substance use and symptom
played at a frequency around the same frequency as the expression in schizophrenia patients [84,85]. Mayo Clinic
patient’s tinnitus [41]. Sleep Aid is a sleep apnea man- Meditation helps patients practice meditation with a short
agement application that records snoring, generates a training video introducing the key concepts of meditation,
graph of the snoring, plays the recorded snoring sound, and 15-minute and 5-minute meditation programs [23].
and provides information about sleep apnea [41].
Three human fall detection applications were proto- Application Distribution
typed using smartphones. Hansen et al. (2005) [78] used In this study, a total of 83 applications were discussed.
a separate wearable tri-axial accelerometer and camera Among them, 57 applications were designed for clini-
phone to build a fall detection system. The accelerom- cians, 11 applications were designed for medical or nurs-
eter processes the data locally that identifies a fall and ing students, and 15 applications were designed to be
send the data to the phone during a suspected fall. The used by the patients. Figure 2 presents the distribution
phone then requests vocal or keypad response from the of these applications for the major smartphone OS plat-
user, and if there is no response it automatically makes forms. 74 applications are developed for at least one OS
an emergency call and sends data and video from the platform and the remaining 9 applications can be
phone’s camera to the emergency system [78]. The user accessed either on a web-enabled or java-enabled smart-
may forget to wear the sensor, however, which remains a phone. None of the six OS platforms (discussed in Ap-
major problem with fall detection systems based on a pendix I) support all of these 74 applications. iOS is the
wearable accelerometer. Zhang et al. (2006) [80] embed- most popular platform for healthcare smartphone appli-
ded the tri-axial accelerometer in the cell phone to over- cations because 57 out of 74 applications are developed
come the problem. In cases of possible falls, the data is for iOS.
Figure 2 Number of Healthcare Applications per OS Platform Discussed in this Study. This figure presents the distribution of the
smartphone-based healthcare applications that are discussed in this study for all of the six major OS platforms. The distribution is describes in
two categories: the first breakdown is according to the intended users, that is, healthcare professionals, medical and nursing students, and
patients; and the second breakdown is according to their latest release or update date, that is, recent (latest update in 2011), contemporary
(latest update during 2009 to 2010), legacy (latest update on or before 2008), or prototype (not released yet for real use).
Figure 2 also presents a breakdown of the number of applications are mainly developed for iOS, Palm and
applications in two categories: (1) intended users (health- Windows Phone platforms. However, three applications
care professionals, medical and nursing students, and for literature search can be accessed from any web-
patients), and (2) their latest release or update date (recent enabled smartphone through their native internet
(latest update in 2011), contemporary (latest update dur- browser. Accordingly, the “Literature Search” applica-
ing 2009 to 2010), legacy (latest update on or before tions are available virtually for any OS platforms. The
2008), or prototype (not released yet for real use)). Most “Clinical Communication” and “HIS Client” applications
of the applications for each platform are intended for are not available for all OS platforms. These applications
healthcare professionals. For example, 74% of the iOS require installation of proprietary servers and the ven-
applications and 71% of the Android applications are for dors of these servers produce the smartphone applica-
healthcare professionals. The percentage of applications tions based on their clients’ requirements. Currently,
for medical and nursing students for each OS platform is clinical communication and HIS client applications are
below 25%. The Windows platform has the highest num- mainly available for iOS, Android, and BlackBerry. The
ber of applications (12.9%) for patients and BlackBerry has “Medical Training” applications are available for iOS
no application for patients. At least half of the applications only. The “General Healthcare” applications, “Medical
have an updated or new version release in 2011. The Education” applications, and applications for patients do
BlackBerry has the highest ratio (80%) of recently released not serve a common purpose in their category. In order
application followed by 71.4% for Android and 59.6% for for these applications to be widely used in practice, they
iOS. The iOS has the highest number of applications but a should be available for all OS platforms. Every medical
large portion (38.6%) of the applications was released in education application except “MobiPocket Reader” is
2009 and 2010. The Palm OS has the least number of total available for iOS. Not a single application in the category
applications but has the highest ratio of legacy (25%) of “Application for Patients” is available for two different
applications. OS platforms.
Symbian OS has a very low coverage of healthcare appli- Using multiple smartphone devices for use of several
cations because only three applications are developed for healthcare applications is not practical for all three user
the OS. Other five OS platforms (i.e. iOS, Android, Palm, groups including healthcare professionals, medical and
Windows, and BlackBerry) have extensive coverage of nursing students, and patients. We believe every health-
healthcare applications because at least one application is care application should be developed for at least the top
available for all of these five OS platforms in each of the 2 to 3 OS platforms. We can observe that there is low
broader category. In the following, the coverage of health- coverage in the following categories: specialist medical
care applications for these five OS platforms is discussed. calculator, clinical communication, HIS client, medical
In “Disease Diagnosis” category, we discussed a total training, general healthcare, medical education and
of nine medical reference applications (i.e. JHABx, applications for patients. The future development should
5MCC, 5MIDC, SG, ePocrates ID, ID Notes, PMID, and focus on increasing the coverage of applications for all
UpToDate) in which at least four of them are available OS platforms in the above mentioned areas.
for all of these five OS platforms. We also discussed six
lab reference applications (i.e. Palm Lab DX, Normal Discussion
Lab Values, Lab Unit Converter, Labs 3600, Davis’s La- Smartphones access clinical applications, evidence-
boratory and Diagnostic Tests, and Pocket Guide to based resources, and advanced mobile communication
Diagnostic Tests) in the same category in which at least in one handheld-sized device at the point of care.
three of them are available for all of these five OS plat- Their mobility enables health professionals to use
forms. There are six other useful “Disease Diagnosis” them in a clinical setting for patient care [88]. This
applications (including Eroentgen Radiology Dx, iSeism- study presents smartphone-based healthcare applica-
ometer, Video Laser Level, EyeChart, EyePhone, and tions that were discussed in the literature. The appli-
DizzyFix) that are available for iOS only except iSeism- cations were categorized based on target users:
ometer that is also available for Windows Phone. clinicians, medical or nursing students, or patients.
For the six “Drug Reference” applications, at least two The functionalities of the applications and supported
of them are available for all of these five OS platforms. smartphone platforms were discussed and presented
Among the nine “Medical Calculator” applications, three in tabular format.
specialist medical calculators (i.e. uBurn Lite, Softforce’s Studies show wide adoption of smartphones by health-
Antibiotic Dosage Calculator, and Paeds ED) are avail- care professionals during recent years [1,2]. Smartphones
able for iOS only and at least two out of six other gen- are becoming popular for clinical use among clinicians,
eral purpose medical calculators are available for all of and medical and nursing students [43,53,55,77,89-91].
these five OS platforms. The “Literature Search” PDAs, the predecessors of smartphones, have been
recognized in a systematic review article as useful delay [12,20,66]. However, mobile communications in
in physicians’ practices for rapid response, error clinical settings may have a negative impact on informal
prevention, and data management and accessibility interaction among workers and require socio-technical
[92]. Real-time clinical information at the point of mechanisms to overcome this [67]. Bedside access, or
care is very important in the practice of EBM, since access at anytime from anywhere, to patients’ clinical in-
clinicians may not seek answers to clinical questions formation from Hospital Information Systems (HISs) can
after completion of a clinical encounter [93,94]. be facilitated through smartphones [20,22,23,51,68]. Also,
Drug reference applications, medical textbooks and electronic capture of patient data into HIS within
references for disease diagnosis, and medical calcu- resource-limited settings in developing countries has
lator applications were reported as the most useful become feasible, using smartphone-based applications
by clinicians and medical and nursing students [101]. However, HIS client applications must comply
[43,53,77,89,91,95]. Single applications may not pro- with national legislation on privacy and security, such as
vide all required information, requiring use of com- the U.S. Health Information Portability and Accountability
binations of applications [40]. Act [102], the European Union’s regulation 95/46/EC on
Medical reference applications, such as the Sanford processing of personal data [103] or the UK National
Guide, Johns Hopkins Antibiotic Guide, 5-Minute In- Health Service’s privacy and confidentiality issues [104],
fectious Diseases Consult, 5-Minute Clinical Consult, etc. [33,51,55,105,106].
and ePocrates ID, provide treatment recommenda- Medical training applications on smartphones make
tions for most cases [46,47]. UpToDate is a useful medical guidelines or CME materials accessible from any-
evidence-based clinical information tool at the point where, including resource-limited settings [25,69-71].
of care, but requires an institutional or personal Current disease outbreak updates, real-time ICU patient
annual subscription [16,17,40,45]. The drug-drug monitoring, and electronic mobile homecare have also
interaction-checking feature of drug reference appli- become feasible as a result of smartphone technology
cations like Epocrates and Skyscape’s RxDrugs is a [39,52,73,75]. Handheld versions of medical books, journals
very useful evidence-based resource at the point of like BMJ and JACC, interactive anatomy tools, medical cal-
care [11,40]. Medical calculators help clinicians culators, medical references, and drug references on smart-
calculate various clinical scores and indices, and phones provide mobile learning opportunities for medical
MedMath and MedCalc were reported as the most and nursing students [11,17,23,41,47,51,56,77,107-109].
commonly used among eight medical calculators Accordingly, these applications may be included in medical
listed in Table 5 [11,43]. or nursing curriculum [76,110].
The literature search applications listed in Table 5 There are many advantages of using smartphone-
facilitate PubMed/MEDLINE search from smart- based healthcare applications in medical practice. For
phones. The use of a specialized medical vocabulary example, they allow for advanced mobile clinical com-
(such as MeSH) in search queries is very effective munications using multimedia functions and provide ac-
for finding relevant citations. Usually, queries con- cess to various clinical resources at the point of care
sisting of three or more medical terms can retrieve such as up-to-date evidence-based clinical resources,
relevant documents to answer clinical questions suc- medical formula calculator, drug reference and inter-
cessfully [63,64]. However, learning effective search action checking, etc. In addition, they can provide secure
strategies using a specialized vocabulary could be remote access to real-time patient monitoring system
impractical for clinicians and the general public and EMR systems for better patient care. Hospitals
[96,97]. Therefore, the NLM developed smartphone- should encourage healthcare professionals to use
based applications like askMEDLINE, PICO, and smartphone-based healthcare applications, and finan-
Disease Associations for non-expert clinical informa- cially support them to keep the applications up-to-date
tion seekers [45,60-62]. The presentation of search with regular update.
results for clinical use on the small screens of smart- Smartphone-based patient oriented applications de-
phones is challenging. The visualization of the search liver healthcare services for patients with chronic condi-
result by grouping or clustering retrieved documents, tions, which is the purpose of mobile health or mHealth
with summary information for the group, was found [29,32,35,79,82,83]. The mHealth component of eHealth
to be useful for effective and intuitive navigation delivers medical and healthcare services through mobile
[24,58,98-100]. devices [111]. The World Health Organization (WHO)
The use of smartphones for mobile clinical communi- has recently defined mHealth as “medical and public
cation facilitates various means of communication health practice supported by mobile devices, such as
among clinicians, such as text messages, email messages, mobile phones, patient monitoring devices, personal
voice, video, and images, and reduces communication digital assistants (PDAs), and other wireless devices”
[112]. The wide adoption of high-functionality smart- physician interactions and communications [122]. The
phones by the general public highlights the increased de- privacy and security concerns of storing or communi-
mand for better mHealth services through smartphones cating patient data with smartphones should be
[3-6,86]. Mobile telemedicine services with video cap- addressed cautiously. These security features of smart-
ability have become viable by using smartphones [30,33]. phones, while not available for all devices, may be
However, while the advancement in smartphone-based useful: data backup, encryption of stored patient data,
mHealth services may be seen in developed countries, remote wiping to destroy all data on a device in case
developing countries have yet to get its potential benefits of loss or theft, and securely encrypted wireless data
[42]. It is anticipated that about 500 million smartphone transmission over WiFi [123-126].
users around the world will use mHealth services by The information contained in healthcare applica-
2015 [113]. Since anyone can implement applications for tions must be accurate. In general, application users
smartphones, healthcare applications need to be con- must agree with the terms and conditions of use of
trolled and validated through appropriate organizations applications to use the applications, and the users are
such as the U.S. Food and Drug Administration (FDA), mainly liable for utilizing the information in the
the Australian Therapeutic Goods Administration applications. As a result, incorrect or outdated infor-
(TGA), the International Federation of Clinical Chemis- mation from healthcare applications may lead to
try (IFCC), etc. [19,26,114]. For example, Abroms et al. medico-legal consequences and users instead of soft-
(2011) [115] examined 47 iPhone applications for smok- ware companies are responsible for them. This prob-
ing cessation that were found to have low adherence to lem may affect many healthcare applications including
clinical practice guidelines. disease diagnosis, drug reference, and medical calcula-
An interesting feature of smartphone devices is Blue- tor applications. The peer reviewed applications (such
tooth, which is a technology for short-distance wireless as JHABx guide) are more reliable than non-peer
data transmission. Nowadays, many medical devices reviewed applications [47]. There are a few articles
(such as glucose meters, thermometers, etc.) have this that discuss the accuracy of some selected applica-
functionality. In order to standardize the interoperability tions [47,127]. Our future work is to provide guide-
between medical devices using Bluetooth, the medical lines for developing and using smartphone-based
working group of the Bluetooth Special Interest Group healthcare applications in medical practices. The focus
provided the specification for Bluetooth Health Device would be on medico-legal and ethical issues regarding
Profile (HDP) [116]. The smartphones should support use of smartphone-based healthcare applications.
built-in Bluetooth HDP for standard Bluetooth commu-
nication with medical devices. This will enable the Limitations
smartphone applications to work with medical devices Many smartphone-based medical applications are avail-
from different vendors. Currently, only the Android plat- able in online application stores (e.g., Apple’s App Store).
form supports built-in Bluetooth HDP (see Appendix I). However, most of them have not been discussed in the
The challenges of smartphone-based healthcare in- medical literature. Those healthcare applications were
clude limited battery life, small screen size, potentially not included in this study. We would like to emphasize
erroneous data input, computer viruses including spy- that our goal was to systematically review articles in the
ware, magnetic interference with medical devices, po- academic literature discussing smartphone-based health-
tentially inefficient patient-physician interactions, loss care applications.
or theft, and breaches of data privacy and security.
Data input is much slower and erroneous on smart- Conclusions
phones using a stylus [117]. Antivirus software must In this study, we discussed many smartphone-based
be used to protect devices from computer viruses and healthcare applications from the literature. These
spyware, and must be updated regularly. The use of applications were grouped according to targeted users
smartphones in hospital environments may have a (i.e., clinicians, medical and nursing students, and
small risk of electromagnetic interference with med- patients). These applications are not intended to re-
ical devices and they should be used with caution in place desktop applications, but to add to existing
certain areas. Studies suggest that using mobile technologies for better healthcare. The functionalities
devices in a normal way beyond a one-meter range of of the applications are growing day by day and new
medical devices is safe [66,118-121]. The interaction functionalities are available with every major release.
between patients and physicians may be hampered by The work of healthcare professionals is very mobile
the use of a PDA during the patient encounter, but in nature. Smartphones enable for advanced mobile
explaining the reason for using a PDA to the patient communication between health professionals, makes
was found to have a positive effect on patient- medical formula calculations available anywhere
anytime, and provides access to evidence-based med- monitoring systems to maximize the power of mobile
ical resources including disease diagnosis guides, drug applications. This will enable healthcare professionals
references, literature search, and continuing medical to use the applications in a more meaningful way for
education materials at the point of care. In addition, better patient care.
smartphones enable health professionals to access to Smartphone-based applications are getting more at-
EMR systems from anywhere thus facilitating remote tention in healthcare day by day; all of the 55
consultation and telemedicine. Moreover, performing articles included in this systematic review were pub-
simple medical exams such as visual acuity test is also lished after 2003 and 24 of these articles were pub-
viable using a smartphone. The wide adoption of lished recently between January 2010 and April 2011.
smartphones by the general public emphasizes the op- The full potential of smartphones has yet to be
portunity of better mHealth and mobile telemedicine exploited. We believe that this study provides a
services through patient oriented applications, for ex- better understanding and greater insight into the
ample, patient education, disease self-management, effectiveness of the smartphone-based healthcare
and remote monitoring of patients. applications in improving patient care and reducing
Most of the applications discussed in the study are healthcare expenses.
standalone applications. There is an immense need for
developing guidelines for standardizing smartphone-
based healthcare applications so that the applications Appendix A
are used together seamlessly for specific purposes and
are integrated with HISs such as EMR and patient Appendix I: Smartphone Platform Overview
Table 1 Smartphone Operating-System Platforms, OS Features
OS Platform ! Symbian Palm Web Windows BlackBerry iOS Android [140,167]
OS [158] OS [159,160] Phone [161] [162,163] [164-166]
Version 3 2.3 7 6 5 4.0
App Store Ovi Store Palm App Catalog Marketplace BlackBerry App World App Store Android Market
Developer Nokia Hewlett Packard (HP) Microsoft Corporation Research In Motion (RIM) Apple INC. Google INC.
OS Feature
Multitasking ✓ ✓ ✓l ✓ ✓ ✓
Notifications ✓ ✓ ✓ ✓ ✓ ✓
System Bar ✓ ✓ ✓ ✓ ✓ ✓
Tool Bar ✓ ✓ ✓ ✓ ✓ ✓
Customizable ✓ × ✓ ✓ ✓ ✓
Home Screen
Recent Apps × × × × ✓ ✓
Text Selection, ✓ ✓ ✓ ✓ ✓ ✓
Copy & Paste
App folders ✓ × × ✓ ✓ ✓
Universal Search × ✓ ✓ ✓ ✓ ✓
Adobe Flash ✓ ✓ ✓ ✓ × ✓
Live Streaming RTSP RTSP RTSP RTSP HTTP HTTP, RTSP
Widgets ✓ × ✓ × × ✓
Encryption ✓ *
× ✓ ✓ ✓ ✓*
Remote Wipe × ✓ ✓ ✓ ✓ ✓
WiFi Security WEP, WPA, WPA2 WEP, WPA, WPA2 WEP, WPA, WPA2 WEP, WPA, WPA2 WEP, WPA, WPA2 WEP, WPA, WPA2
Multilingual ✓ ✓ ✓ ✓ ✓ ✓
Accessibility ✓ ✓ ✓ ✓ ✓ ✓
This table compares the operating-system features of six smartphone platforms: Symbian OS, Plam Web OS, Windows Phone, BlackBerry, iOS, and Android.
✓ This feature is supported by the OS platform.
× This feature is not supported by the OS platform.
✓* This feature is supported in a limited number of devices.
✓l The functionality presented by this feature is limited.
Table 2 Smartphone Operating-System Platforms, Features Support with Hardware

OS Platform ! Symbian Palm Web OS Windows BlackBerry iOS Android
OS [158] [159,160] Phone [161] [162,163] [164-166] [140,167]
Touch screen ✓* ✓ ✓ ✓ ✓ ✓
Multi-touch User ✓ ✓ ✓ ✓ ✓ ✓
Interface
Virtual Keyboard ✓ ✓ ✓ ✓ ✓ ✓
External Keyboard ✓ ✓ ✓ ✓ ✓ ✓
Camera ✓ ✓ ✓ ✓ ✓ ✓
Video Recording ✓ ✓ ✓ ✓ ✓ ✓
Video Calling × × × × ✓ *
✓*
USB Interface ✓ ✓ ✓ ✓ ✓ ✓
Voice Command ✓ × ✓ ✓ ✓ ✓
Tethering ✓ ✓ × ✓ ✓ ✓
Multicore Processor × ✓ *
× × ✓ *
✓*
Support
Accelerometer ✓* ✓ ✓ ✓ ✓ ✓
Gyroscope × × ✓ × ✓ ✓
Switch Screen ✓ ✓ ✓ ✓ *
✓ ✓
Orientation
GPS ✓ ✓ ✓ ✓ ✓ ✓
Bluetooth ✓ ✓ ✓ ✓ ✓ ✓
Built-in Bluetooth × × × × × ✓
Health Device Profile
WiFi ✓ ✓ ✓ ✓ ✓ ✓
3G/4G 3G 4G 3G 3G 4G 4G
This table compares the support of features by six smartphone OS platforms with the availability of hardware in the device.
✓ This feature is supported by the OS platform.
× This feature is not supported by the OS platform.
✓* This feature is supported in a limited number of devices.
Smartphones platforms for. . .third-party applications. . ..having more

Smartphones are essentially cell phones with advanced processing power and memory. . .multiple connections,
connectivity and computing capability. There is no such as WiFi and Bluetooth, multimedia applications, such
standard definition of smartphone found in the indus- as photos, music, and video, and GPS functions” [129].
try. In the annual report published in 2010 by the U.S. The first commercial cell phone was released publicly in
Federal Communications Commission (FCC), smart- 1983, 10 years after a cell phone prototype was first pub-
phones are defined as mobile devices with cell-phone licly demonstrated in April 3, 1973 with a call placed by
capability having “an HTML browser that allows easy Martin Cooper, the general manager of Communications
access to the full, open Internet; an operating system Systems division at Motorola [130]. Since then, the devel-
that provides a standardized interface and platform for opment of cell phone technology has advanced very
application developers; . . .a larger screen size than a quickly due to the huge demand. The advancement of cell
traditional handset. . .and touch screens and/or a phone technology includes more powerful microproces-
QWERTY keypad” [128]. Another report submitted to sors, larger screen, and longer battery life. In a parallel
the FCC by the Telecommunication Industry Associ- trend, handheld-sized computers or Personal Digital
ation (TIA) in 2010 defined a smartphone as “a mo- Assistants (PDAs) emerged in the early 1990’s with the ad-
bile device that offers the most advanced compu- vancement of computer technology. Most recently, cell-
ting ability and connectivity available today. . ..having phone capability has been introduced in PDAs, reducing
intelligence similar to personal computers while offer- the need to carry two separate devices, and producing the
ing the capabilities of a mobile phone. . .running so-called smartphone. Thus, smartphones are the conver-
robust operating systems (OS) software that provides gent technology of cell phones and PDAs [131]. In
addition to phone services (voice calling, text and multi- In some smartphones, the home screen is customizable
media messaging, etc.), the common functionality of to allow the user to add or remove application shortcuts
smartphones includes e-mails, calendars, contact lists, in the home screen, and also allows the user to drop
task lists, camera and video capabilities, and Internet widgets onto the home screen. The app folder facilitates
access [132]. Smartphones are also generally equipped storing applications in a special system-defined folder,
with Bluetooth, WiFi and USB connectivity. and all recently used applications are displayed in recent
apps. Smartphones now support text selection, copying
Smartphone Platforms to the clipboard, and pasting anywhere. The search box
Smartphones are usually based on specially designed oper- may combine searching of the Web and the device in-
ating system (OS) platforms for mobile computing and ternally together, which is called universal search. The
phone services. These OS platforms are now capable of Adobe Flash support is very attractive to the user as it
running third-party applications including medical and allows all the flash based resources (e.g. games, videos
healthcare applications, which is a great advantage of smart- etc.) from the Web. HTTP or RTSP live streaming facili-
phones [26]. There are six major smartphone OS platforms: tates real-time audio or video streaming. Data security
Symbian OS, Palm OS, Windows Phone, BlackBerry, iOS, can be enhanced by storage area encryption, remote wip-
and Android. Figure 3 illustrates three-month market-share ing (during loss or theft), and WiFi security for secure
averages for different smartphone OS platforms in the U.S. wireless data transmission. Some platforms also support
from February 2010 to May 2011 [3-5]. Figures 4 and 5 il- accessibility features for the disabled [129,135-138] and
lustrate worldwide market share forecasts of smartphone multiple languages.
platforms through 2015, published during the first quarter Table 2 illustrates the support of common features
of 2011 by IDC [133] and Gartner [134] respectively. by smartphone OS platforms with the availability of
An overview of OS features of smartphone platforms is hardware in the device. These are touch screens,
illustrated in Table 1. All of the platforms provide stand- multi-touch user interfaces, virtual keyboards, external
ard applications such as organizers, contact lists, e-mail, keyboards, cameras, video recording, voice com-
Web browsers, photo galleries etc. The multitasking fea- mands, tethering (Internet-connection sharing with
ture allows multiple applications to run concurrently. other devices using cable, Bluetooth, WiFi, etc.),
The notification system bar displays system status (e.g. multi-core processor support, accelerometers, gyro-
battery, network, etc.) and notification (e.g. received text scopes, screen re-orientation, Global Positioning Sys-
messages, email messages, etc.) while the user works on tem (GPS) features, Universal Serial Bus (USB)
an application window, and the toolbar facilitates control connections, and wireless connections (Bluetooth,
buttons (e.g. maximize, minimize, close) for applications. WiFi, 3G/4G).
Figure 3 Smartphone U.S. Market Share Feb-2010 to May-2011 [3-5]. This figure presents the market share of five major smartphone
platforms (i.e. Palm Web OS, Windows Phone, BlackBerry, iOS, Android) in the United States during the period of 2010 – 2011. In the middle of
2011, Android has become the leader in smartphone market share while all other platforms have shown decreasing trend except iOS. The market
share of iOS was almost consistent during this period.
Figure 4 Smartphone Worldwide Market Share Forecast 2015 [133]. This histogram presents the worldwide market share forecast data from
IDC for six smartphone OS platforms in 2015. Android is predicted to be the global market leader in smartphones acquiring almost half of the
market share by 2015.
Symbian OS Tables 1 and 2 except recent apps, universal search

Symbian OS was developed by Symbian Ltd. and (it supports internal search only), remote wiping, video
subsequently acquired by Nokia. The most recent re- calling (third-party software may be available), multi-
lease of this platform is Version 3 as of June 2011. core processor support, and gyroscopes. Stored-data
This platform is prominent globally but not in the encryption and accelerometers are available on selected
U.S. [6,134]. Symbian OS had nearly 40% of global devices only.
market share in 2010 but was forecast to be below
1% by 2015 (Figures 4 and 5), which may be due to Palm Web OS
Nokia’s February 2011 announcement to shift from Palm Web OS (Version 2.3 as of June 2011) is the suc-
Symbian OS to Windows Phone 7 [133,134,139]. cessor of Palm OS, which was introduced in January
Symbian OS supports almost every feature listed in 2009 by Palm and acquired by Hewlett Packard (HP) in
Figure 5 Smartphone Worldwide Market Share Forecast 2010–2015 [134]. This figure presents the market share forecast data from Gartner
for five smartphone OS platforms up to 2015. Android is predicted to be the leader in smartphone market by 2015 acquiring almost half of the
market share. Symbian OS will lose almost all of the market share since its vendor Nokia announced in February, 2011 to shift from Symbian OS
to Windows Phone 7 [153], thus global market share for Windows Phone is forecast to gain by 2015, placing the platform in second position.
February 2011. Palm has a small market share in the U.S. decrease little before 2015 (Figures 4 and 5). BlackBerry
with a decreasing trend during 2010–2011 (See Figure 3). Version 6 is only available in newly released BlackBerry
Palm supports almost all the features listed in Tables 1 and devices, and devices with old platforms cannot be
2 except recent apps, app folders, widgets, storage-area upgraded to version 6. This platform does not support
encryption, video calling, voice commands, and gyro- recent apps, widgets, external keyboards, video calling,
scopes. Palm provides multi-core processor support but tethering, or multi-core processor support. The remote
this is currently available in touch-pad devices only, not in wiping feature is available through the BlackBerry Protect
smartphone devices. application, which is available free of cost.
Windows Phone iOS

Windows Phone (Version 7 as of June 2011) is the succes- iOS (Version 5 as of November 2011) was developed
sor of the Windows CE and Windows Mobile platforms by Apple for their iPhone (the only smartphone based
developed by Microsoft. During 2010–2011, Windows on iOS), iPod, and iPad. Its 2010–2011 U.S. market
Phone lost about 9.3% of U.S. market share within a 15- share was consistently around 25%, placing it in sec-
month period (Figure 3); however, global market share is ond position at the end of May 2011 (Figure 3). The
forecast to gain by 2015, placing the platform in second global market share forecast is also consistent
position (Figures 4 and 5). Nokia announced in February through 2015 with some fluctuations, remaining in
2011 a switch from Symbian OS to Windows Phone [139]. third position by 2015 (Figures 4 and 5). This is the
The multitasking support in Windows Phone is restricted only platform among the six platforms discussed in
to allowing third-party applications to run limited actions this article that does not support the popular Adobe
in the background. Unsupported features are recent apps, Flash Player. There is also no support for installing
app folders (folders are arranged in hubs), support for widgets, and multi-core processor support is available
external keyboard, video calling, tethering, and multi-core only on the iPad. The video calling functionality is
processor support. Windows phones provide a hardware available using the FaceTime application (developed
button to facilitate universal search. by Apple) in iPhone 4, iPod, and iPad. This platform
is very prominent for its user interface and multi-
BlackBerry touch gesture functionality. Unlike other platforms,
BlackBerry (Version 6 as of June 2011) was developed notifications are not displayed in the system bar and
by Research In Motion (RIM) of Canada and is very the user needs to slide down from the top to access
prominent in the U.S. BlackBerry lost 17.4% of U.S. notifications. The iPhone is only smartphone device
market share in a 15-month period during 2010–2011 available based on iOS, and no future plans have been
(Figure 3), but its global market share was forecast to announced to release others.
450,000
Application Store Size
400,000
350,000
Number of Applications
300,000
Apple's App Store (iOS)
250,000 Google's Android Market
200,000
150,000
100,000
50,000
0
July'08 Nov'08 Mar'09 July'09 Nov'09 Mar'10 July'10 Nov'10 Mar'11 July'11 Nov'11
Month
Figure 6 Number of Applications in Apple’s App Store and Google’s Android Market (July’08 – Nov’11) [141-156]. This figure presents
the growth rate of two major smartphone application stores: Apples’s App Store and Google’s Android Market, during the period of July, 2008 to
November 2011. Both of the stores are growing very fast. According to the most recent updates, the total number of applications in Apple’s App
Store is more than 425,000 as of July, 2011 [141] and in Android Market is more than 352,800 as of November, 2011 [152]. Overall, the Apple’s
App Store is currently leading in terms of the application store size; however, the growth rate is much slower than Android Market.
Android slower than Android’s (Figure 6). As seen in Figures 3, 4

Android (Version 4.0 as of November 2011) is an open- and 5, Android is currently leading both of the U.S.
source platform that was initially developed by Android and Global market share, and the growth rate of its
and later purchased by Google. This platform is becoming application stores is almost proportional to the increase
prominent in the U.S. as well as globally [6,133,134]. An- in market share during the period of 2010 – 2011. An-
droid U.S. market share increased from 9% to 38.1% within droid also leads in the total number of free applica-
a 15-month period during 2010–2011, placing this plat- tions, and has become an increasingly popular
form in the top position (Figure 3). Android is predicted competitor of iOS (for iPhone) [151,157]. The market
to be the global market leader in smartphones, acquiring share of iOS is almost consistent during the period of
nearly 50% market share by 2015 (Figures 4 and 5). This 2010 – 2011 though its application store size increased
platform supports all the features listed in Tables 1 and 2, (Refer to Figures 3, 4 and 5 for details).
but some features (storage-area encryption, video calling,
and multi-core processor support) are available in selected
smartphone devices only. The system bar provides a soft- Appendix II: Healthcare Applications for
ware navigation button in addition to system status and Smartphones
notifications. Of the six major OS platforms, only Android In this study, a total of 83 smartphone-based healthcare
4.0 has built-in support for connecting to Bluetooth Health applications were discussed. These applications were
Device Profile (HDP) devices [140]. grouped by the targeted user of the applications, as
divided into three groups: (1) 57 applications for health-
Smartphone Applications care professionals, (2) 11 applications for medical or
The total number of applications in application stores nursing students, and (3) 15 applications for patients.
(especially in the Apple’s App Store (iOS) and Google’s The functionalities of the applications and supported
Android Market) is growing very fast (Figure 6) [141-156]. smartphone platforms were discussed and presented in
According to the latest “Apple Press Info” on Apples’ App tabular format. Tables 3, 4, 5, 6, 7, 8, 9 and 10 presents a
Store, there are more than 425,000 applications as of July, total of 57 applications for healthcare professionals;
2011 [141]. The Google’s Android Market has more than Table 3: 21 disease diagnosis applications, Table 4: 6
352,800 applications as of November, 2011 according to drug reference applications, Table 5: 8 medical calculator
the recent update from Distimo [152]. The total number of applications, Table 6: 6 literature search applications,
applications for other four OS platforms is very low. As of Table 7: 3 clinical communication applications, Table 8:
March 2011, a total of 29,920 applications are available in 4 HIS client applications, Table 9: 2 medical training
the Ovi store (Symbian OS), 26,771 in the BlackBerry App applications, and Table 10: 7 general healthcare
World, 11,731 in the MarketPlace (Windows Phone), and applications. The applications for medical and nursing
6,363 in the Palm App Catalog [151]. Overall, the iOS leads students and patients are listed in Tables 11 and 12
in the number of applications, but its growth rate is much respectively.
Table 3 Disease Diagnosis Applications
Application Version (price) Platforms Description Functions
Johns Hopkins 1.10.4 ($39.95) iOS, Android, An application to Includes information on anti-microbial
Antibiotic Guide Palm OS, Windows help clinicians in the agents, infectious diseases, and commonly-
URL1
[11,39,46,47] Mobile, BlackBerry diagnosis and treatment of encountered pathogens; provides expert
infectious diseases. recommendations, evidence-based
recommendations, drug lists, and drug-drug
interactions.
5MCCURL2 [43,46] 2011 ($99.95 – 1 year) Android, BlackBerry, iOS, The handheld version of the Includes information about diagnosis,
Palm OS, Windows Mobile 5-Minute Clinical Consult treatment, medications, follow-up, and
(5MCC) guide. associated conditions for 900-common
medical conditions; treatment algorithms
such as Acromegaly, Swine Flu (H1N1),
etc.; flowcharts of related algorithms and
protocols; drug therapy section in each
topic; ICD-9-CM code index.
5-Minute ($89.95 – 1 year) Android, BlackBerry, iOS, An application for clinical Includes more than 500 topics;
Infectious Diseases Palm OS, Windows Mobile diagnosis, laboratory testing, topics are arranged alphabetically.
ConsultURL3 [39,46] and appropriate therapy
of infectious diseases.
Sanford Guide to 2011 ($29.99) Palm OS, Windows Mobile, The pocket edition of the Home, back and search buttons; four rapid
Antimicrobial iOS, BlackBerry. Sanford Guide to reference categories; diseases and clinical
Antimicrobial Therapy. conditions are organized by site of infection
Table 3 Disease Diagnosis Applications (Continued)

Therapy URL4 and organism; drug information is organized
[11,16,46,47] by type; activity spectra comparison table
(color coded) for bacteria, fungi and viruses;
internal links for efficient navigation.
ePocrates ID URL5 Rx Pro ($99.00 – 1 year) Palm OS, Windows Mobile, An infectious-disease Provides information on more than 300
[39,46,47] iOS, BlackBerry, Android application infections, 350 pathogens and 250 drugs;
for smartphones; part of alphabetical list or search of anatomic location,
ePocrates Rx Pro. infection, bug or drug; information on
pathogen specific drug therapy, history and
diagnosis of infection, drug interactions,
adverse reactions, basic pharmacological
information, and drug cost; references to
review articles; ability to record personal notes.
Infectious Diseases ($39.99) Palm OS An application to help Includes organisms and treatments,
Notes URL6 [47] clinicians in infectious prophylactic therapy, antimicrobial
disease treatment. spectra index, and normal flora index.
UpToDate URL7 ($495 – 1 Year) iOS, web-enabled An online tool providing Includes more than 9,000 physicians topics,
[11,16,17,40,45] smartphone evidence-based clinical about 5,000 drug topics, patient information,
information (e.g. answering “what’s new” alerts, practice-changing
clinical questions, making updates, abstracts, CMEa credit accrual,
treatment recommendations) search filters (adult, pediatric, patient),
auto-completion of search terms.
Pocket Medicine 3.0 ($50.00) Palm OS, An application that answers Suggestions for therapy; subjects are
Infectious Windows Mobile questions about disease categorized as history and physical, tests,
Diseases URL8 [46] diagnosis. differential diagnosis, management, specific
therapy, follow-up, complications, and
prognosis; “what to do first” guidance.
Palm LabDX [44] Prototype Palm OS, An application containing Displays alphabetical listing of tests; search
Windows CE information on 193 by test name; display test information such
common laboratory tests. as reference range; causes for increased
and decreased values, descriptions of tests,
and notes on interpretation and related tests.
Normal Lab 1.4 ($1.99) iOS An application to help Shows reference values both in traditional
Values URL9 [26] interpret laboratory test and SIb units, visualizes labs by categories
results. or alphabetical list, search field.
Lab Unit 1.2 ($4.99) iOS An application to convert 250 common lab tests; quick access to
Converter URL10 lab values between frequently used conversions; search lab tests.
[26] conventional and SIb units.
Labs 360URL11 ($49.95 – 1 year standard Android, BlackBerry, iOS, A laboratory guide edited Includes all common laboratory tests,
[26] subscription) Palm OS, Windows Mobile. by a practicing clinician. providing high and low values;
cross-reference all skyscape resources;
updates every 4–6 weeks.
Davis’s Laboratory ($49.95) Android, BlackBerry, iOS, A nursing-focused laboratory Provides test procedure information on over
and Diagnostic Palm OS, Windows Mobile. and diagnostic test 400 labs; patient care before, during, and after
Tests URL12 [26] reference. the test; RSS feeds of clinical lab-product news;
list of drug-test interactions; sub-specialty
information.
Pocket Guide to ($39.95 – 1 year standard Android, BlackBerry, iOS, A diagnostic and laboratory Includes laboratory procedures in clinical
Diagnostic subscription) Palm OS, Windows Mobile. test reference designed for settings; laboratory tests, diagnostic imaging
Tests URL13 [17,26] medical, nursing and other tests, costs and risks of various procedure;
health professional students. flowcharts of complex algorithms; color
images; cross-reference to all other Skyscape
applications.
IDdx URL14 [23] 1.10 ($1.99) iOS, Palm OS, Windows A decision support software Explores 275 diseases in 15 categories;
Mobile, BlackBerry tool to help medical search by disease name or disease criteria
practitioners to diagnose (includes 119 signs and symptoms, 39
infectious diseases. epidemiological factors, 16 regions of the
world); examples of epidemiological factors;
access diseases worldwide; drill down to the
infections associated with compromised
hosts or bioterrorism.
($19.99) iOS A smartphone application Identifies most appropriate radiology exam
that helps radiologists to for a patient; informs choice of the best test
Table 3 Disease Diagnosis Applications (Continued)

eRoentgen identify the most the first time around; searches by diagnosis
Radiology appropriate radiology exam and symptoms.
Dx URL15 [23] for a patient.
iSeismometer URL16 1.3 (free) iOS, Windows Phone A tool for rapid Measure and display of movement in X, Y, Z
[48] measurement of tremor axis and their predominant frequency band.
frequency using the
iPhone accelerometer.
Video Laser 1.0 ($1.99) iOS Positions virtual red Allows oculoplastic surgeons to evaluate
Level URL17 [49] horizontal lines alignment and misalignment of canthal
over the live video. position during surgical planning, execution,
and follow-up.
EyeChart URL18 [41] 1.1 (free) iOS An application for visual Includes the Snellen eye chart that is used
acuity tests. by eye care professionals to measure visual
acuity.
EyePhone URL19 1.0 ($25.00) iOS An application for visual Distance E-test, near visual acuity test,
[42] acuity test. fixating, flash light, color test, Amsler grid,
and pupil diameter test.
DizzyFIX URL20 [41] 1.3 ($14.99) iOS Assists clinicians in correctly Assists in doing Epley Maneuver, which is
diagnosing and treating recognized as the primary treatment of
vertigo due to BPPVc. BPPVc, assists clinicians in guiding patient
through the correct series of precise head
and body positions; video tutorial is available
at http://www.youtube.com/v/nDTDRocg
FKQ&hl=en_US&fs=1
This table presents the version, platforms, a short description, and a list of functions of the 21 disease diagnosis applications for healthcare professionals.
a
CME: Continuing Medical Education, bSI: International System of Units, cBPPV: Benign Paroxysmal Positional Vertigo.
Website URLs:
URL1: http://hopkins-abxguide.org, Accessed June, 2011.
URL2: http://www.skyscape.com/estore/ProductDetail.aspx?ProductId=2711, Accessed June, 2011.
URL3: http://www.skyscape.com/estore/productdetail.aspx?productid=265, Accessed June, 2011.
URL4: http://www.sanfordguide.com, Accessed June, 2011.
URL5: http://www.epocrates.com/products/rxpro/index.html, Accessed June, 2011.
URL6: http://pdamedicalsolutions.com/products/idn.htm, Accessed June, 2011.
URL7: http://www.uptodate.com/home/about/mobile-access.html, Accessed June, 2011.
URL8: http://www.pocketmedicine.com/?q=products, Accessed June, 2011.
URL9: http://doctorcalc.com/normal-lab-values, Accessed June, 2011.
URL10: http://doctorcalc.com/lab-unit-converter, Accessed June, 2011.
URL12: http://www.unboundmedicine.com/products/davis_labs_diagnostic_tests, Accessed June, 2011.
URL14: http://www.iddx.info/, Accessed June, 2011.
URL15: http://www.iatrossoftware.com/, Accessed June, 2011.
URL16: http://www.iseismometer.com/category/apps/, Accessed June, 2011.
URL17: http://itunes.apple.com/us/app/video-laser-level/id331550022?mt=8, Accessed June, 2011.
URL18: http://www.dokcompany.com/products, Accessed June, 2011.
URL19: http://www.eyephone.com.br/Eyephone/Home.html, Accessed June, 2011.
URL20: http://www.dizzyfix.com/professionals/dizzyfix-iphone, Accessed June, 2011.
Table 4 Drug Reference Applications

Skyscape’s 1.1 (free) Android, BlackBerry, An application that provides Includes thousands of brand-name and generic
RxDrugsURL21 [39] iOS dosing guidelines for drugs. drugs and dosages; drug-drug interactions with
multi-drug analyzer tool; access medications by
indication, pharmacologic class or by generic or
U.S. or Canadian brand name; integrated
weight-based drug dosing calculators.
Epocrates URL22 3.18 (free) Palm OS, Windows A drug database application that Provides clinical information on thousands of
[11,39,40,43,50,51,53] Mobile, iOS, is part of Epocrates Rx, which is a prescription medicines; formulary information;
BlackBerry, Android free product. identify pills by entering physical characteristics
and imprint code; multi-drug interaction checker.
Medscape URL23 [39] 2.4.1 (free) iOS, BlackBerry, A drug reference application Includes comprehensive drug reference, drug
Android for smartphones. interaction checker, disease and condition
Table 4 Drug Reference Applications (Continued)

reference and treatment guide, procedures
reference, daily medical news and alerts,
physician, pharmacies, and hospital directories.
SafeMed 2.0 Windows Mobile An application that provides Contains drug listings from the FASS
Pocket URL24 [52] access to data on all (an encyclopedia that is equivalent to American
pharmaceuticals that are sold Physician’s Desk Reference, containing detailed
in Sweden. information of the medicines that are licensed for
sale in Sweden), ICD-10 codes, medical literature,
and pharmaceuticals interactions.
FDA Drugs URL25 [39] 1.8 ($2.99) iOS A tool that provides authoritative Includes 16,466 approvals for 25,881 drug products
info for FDAc drug approvals. since 1939; free monthly updates; search generic
drugs for brand name drugs and vice versa; search
drug name and active ingredient; covers all drugs
from the Orange Book; strength, manufacturer,
FDAc approval date, package inserts
(description, clinical pharmacology, etc.).
DrugDoses.net URL26 [39] 2.0 ($19.99) iOS, Windows A smartphone version of Frank Contains more than 2000 drug dosages for both
Mobile, Android, Shann’s booklet on drug dosages children and adults; search by drug name; integrates
Palm OS for children and adult. PedCalc (pediatric score and formula calculator) and
resuscitation dose calculator for children.
This table presents the version, platforms, a short description, and a list of functions of the six drug reference applications for healthcare professionals.
d
FDA: Food and Drug Administration.
Website URLs:
URL22: http://www.epocrates.com/products/rx/, Accessed June, 2011.
URL23: http://www.medscape.com/public/mobileapp, Accessed June, 2011.
URL24: http://www.pharmtech.se/en/broschyrer/SafeMedPocket_Pharmtech_Eng.pdf, Accessed June, 2011.
URL25: http://sigmaphone.com/app.html#FDA, Accessed June, 2011.
URL26: http://www.drugdoses.net/, Accessed June, 2011.
Table 5 Medical Calculator Applications

Epocrates 3.18 (free) Palm OS, Windows A medical calculator application Provides useful medical formula calculator
MedMath URL27 [11,43,47] Mobile, iOS, that is part of Epocrates Rx and including pregnancy wheel, and basal
BlackBerry, Android available for free. energy expenditure etc.
MedCalc URL28 2.3 ($0.99) iOS An application that provides More than 200 medical formulas, scores,
[11,42,43,55] medical formula calculator. scales, and classifications, detailed information
and bibliographic references for each formula,,
support for U.S. and SIe units, search for
equations by name or keywords, customizable
list of favorite equation.
Medical 1.9 ($0.99) iOS An application that compute Includes common formulas and equations,
Calculator URL29 [26,41] useful medical formulas and supports U.S. and SIe units.
equations.
Calculate URL30 [26] 1.3 (free) iOS, BlackBerry, A medical formula/equation Supports SIe and imperial units, detailed
Android calculator and decision support references with PubMed integration, navigate
tool. calculators by specialty.
Archimedes URL31 [16,39] (free) Android, BlackBerry, Smartphone version of This application includes more than 150
iOS, Palm OS, Archimedes online medical commonly used medical formulas, calculator
Windows Mobile calculator. selection through multiple indexes, use
conventional (U.S.) or SIe units, and formula
details and explanations.
uBurn Lite URL32 [56] 3.1.2 (free) iOS An application to calculate percent Calculate percent burn of body surface area
burn of body surface area. for adult and children, and parkland formula.
Softforce’s Antobiotic 1.2($1.99) iOS A drug dosage calculator for Calculation based on cockroft-gault formula,
Dosage Calculator URL33 [39] the treatment of patients with dosage required for a particular drug, and
renal failure. dosage adjustment.
Table 5 Medical Calculator Applications (Continued)

Paeds ED URL34 [41] 1.0.7 (free) iOS A drug dosage calculator to Use guesstimate formula to calculate weight
be used by the Pediatrician. of children from their age in years, calculate
correct doses of various drugs based on
children’s weight.
This table presents the version, platforms, a short description, and a list of functions of the eight medical calculator applications for healthcare professionals.
e
SI: International System of Units.
Website URLs:
URL27: http://www.epocrates.com/products/rx/, Accessed June, 2011.
URL28: http://medcalc.medserver.be/iphone_description.html, Accessed June, 2011.
URL29: http://doctorcalc.com/medcalc, Accessed June, 2011.
URL30: http://www.qxmd.com/apps/calculate-by-qxmd, Accessed June, 2011.
URL32: http://www.uburnapps.com/uBurn/uBurn_Lite.html, Accessed June, 2011.
URL33: http://www.softforceapps.com/adc/, Accessed June, 2011.
URL34: http://iedapps.com/medical-apps/ied-paediatric-emergency-drugs/, Accessed June, 2011.
Table 6 Literature Search Applications

URL35
PubSearch [51] 1.6 (free) iOS An application for medical literature Searches PubMed; display search results; sort by
searches from PubMed. authors, title, journal or year; display article’s
abstract; bibliographic entry.
PubMed on Tap URL36 2.6 ($2.99) iOS A medical literature search tool Searches and displays reference information from
[41,42,56] for iPhone. PubMed; store references in a searchable personal
library; email references from within the application;
advanced search specifying search field and using
logic operators; links to full text articles; remember
recent searches; navigation between references.
MD on Tap URL37 2.1 (free) Palm OS, An application that retrieves MEDLINE Searches using 3 search engines: PubMed, Essie,
[50,55,57-59,63-65] Windows CE, citations through Internet connections. and Google; previous query history; save citations
Windows Mobile as text file; take notes; cluster search results; related
articles; auto spell check; links to full-text article.
URL38
askMEDLINE (free) Web-enabled A natural language query tool for Searches PubMed by entering natural language
[45,60-62] smartphone. PubMed/MEDLINE developed query; spell checker; handles query in the form of
by the NLMf. questions or complex phrases; MeSH speller
available in “MeSH Speller + askMEDLINE” program
that is an extension of askMEDLINE.
PICO URL39 [45,60,62] (free) Web-enabled A Patient, Intervention, Comparison Includes 4 text fields: problem, intervention,
smartphone. and Outcome (PICO) search interface compare to, and outcome.
for PubMed/MEDLINE developed
by the NLMf.
Disease (free) Web-enabled A search interface for case reports and Includes three text entry fields: (1) two text fields
URL40
Associations [45] smartphone. review of reported cases in for sign, symptom, disease, condition, or procedure
PubMed/MEDLINE developed by NLMf. joined with AND operator, (2) one text entry
associated with that disease, condition, or procedure.
This table presents the version, platforms, a short description, and a list of functions of the six literature search applications for healthcare professionals.
f
NLM: National Library of Medicine.
Website URLs:
URL35: http://www.deathraypizza.com/deathraypizza/PubSearch_Home.html, Accessed June, 2011.
URL36: http://www.referencesontap.com/, Accessed June, 2011.
URL37: http://mdot.nlm.nih.gov/proj/mdot/mdot.php, Accessed June, 2011.
URL38: http://askmedline.nlm.nih.gov/ask/ask.php?from=tbld, Accessed June, 2011.
URL39: http://pubmedhh.nlm.nih.gov/nlmd/pico/piconew.php, Accessed June, 2011.
URL40: http://askmedline.nlm.nih.gov/ask/da.php?from=tbld, Accessed June, 2011.
Table 7 Clinical Communication Applications

Voalté One URL41 1.3.3 (free, but must purchase iOS, BlackBerry A communication tool within the Combines phone calls, text messaging,
[51] and install Voalté server) hospital to simplify communication and prioritized alarm alerts in a single
among clinicians. device; PBXg integration over VoIPh; log
and retrieve all alarms.
2.2 (free, but requires a iOS, Android, A messaging and alerting application Separates critical email and SMSi messages
connection to supported BlackBerry for use in healthcare. from less important ones; audit trail that
Table 7 Clinical Communication Applications (Continued)

Amcom Mobile Amcom Web/Console call logs time and date along with all messages;
Connect URL42 center system) acknowledgement of messages.
[51]
mVisum URL43 (free, but must purchase iPhone, Android, A cardiology communication Receives monitor data, alarms, ECGsj, lab
[20] and install mVisum Medical Windows Mobile, application for cardiologist’s that results, echocardiograms*, MRIsk,*, discharge
Communication System) Blackberry receive patient data on smartphone. notes and other reports. [* These have not
yet received FDAl clearance as of
June 2011.]
This table presents the version, platforms, a short description, and a list of functions of the three clinical communication applications for healthcare professionals.
g
PBX: Private Branch Exchange, hVoIP: Voice over Internet Protocol, iSMS: Short Message Service, jECG: Electrocardiography, kMRI: Magnetic resonance imaging,
l
FDA: U.S. Food and Drug Administration.
Website URLs:
URL41: http://www.voalte.com/Products.aspx, Accessed June, 2011.
URL42: http://www.amcomsoftware.com/Solutions/smartphone_and_tablet_messaging/, Accessed June, 2011.
URL43: http://www.mvisum.com/mVisumCCS.php, Accessed June, 2011.
Table 8 HIS Client Applications

m
OsiriX 2.0.2 ($29.99) iOS A DICOM viewing program that Standard DICOMm query and retrieval; views and
Mobile URL44 is the client application for OsiriX PACSn. processes DICOMm images; zooming, panning,
[22,23,51,68] rotation, windowing, and leveling; calibrated
distance measurement; Oval ROIo measurements
of area and density/signal intensity; image transfer.
MEDITECH URL45 N/A Web-enabled Access patient record from MEDITECH Accesses clinical data including lab results, vital
[20] smartphone. EMRp system securely on smartphone signs, intake and output, allergies, active
using a Web browser medications, and documents (reports and notes).
PatientKeeper N/A Web-enabled Provides access to patients’ clinical Accesses patient list, patient summary, lab results,
Mobile Clinical smartphone. data from PatientKeeper EMRp using test results, medication list, clinical notes, problem
Results URL46 [20] a Web browser list, vital signs, allergies, order status etc.; customizes
workflow based on each physician’s requirements.
URL47
AirStrip OB 1.6(free, but needs iOS, Provides access of hospital’s Labor and Displays real-time and historical waveforms,
[23] to purchase and Android Delivery unit in the EMR to the HIPAAq complaint authentication login, displays
install Airstrip Obstetricians from smartphone. the fetal strip and maternal contraction pattern
OB system) information for an individual patient, access
patient data, and zooming and scrolling chart
images.
This table presents the version, platforms, a short description, and a list of functions of the four HIS client applications for healthcare professionals.
m
DICOM: Digital Imaging and Communications in Medicine, nPACS: Picture archiving and communication system, oROI: Region of Interest, pEMR: Electronic
Medical Record, qHIPAA: Health Insurance Portability and Accountability Act.
Website URLs: URL44: http://www.osirix-viewer.com/, Accessed June, 2011.
URL45: http://www.meditech.com/productbriefs/pages/ProductBriefsCSPCM.htm, Accessed June, 2011.
URL46: http://www.patientkeeper.com/products/clinical_applications/clinical_results_mobile.html, Accessed June, 2011.
URL47: http://www.airstriptech.com/Portals/_default/Skins/AirstripSkin/tabid/61/Default.aspx, Accessed June, 2011.
Table 9 Medical Training Applications

URL48 r
iCPR (D-Sign.it, Lite-1.3 (free), iOS An application for CPR training, based on CPRr tutorial; measures chest compression
Bologna, Italy) [71] Full-1.1 (free) both American Heart Associationand rate; gives audiovisual feedback.
European Resuscitation Council guidelines.
iResus URL49 [70] 1.41(free) iOS Provides access to UK’s resuscitation Includes adult and pediatric algorithms; displays
guidelines algorithms. algorithms in an intuitive and interactive format;
pulls latest algorithms from a central server.
This table presents the version, platforms, a short description, and a list of functions of the two medical training applications for healthcare professionals.
r
CPR: Cardiopulmonary Resuscitation.
Website URLs: URL48: http://www.icpr.it/, Accessed June, 2011.
URL49: http://www.imobilemedic.com/productDescription.php?prodID=2, Accessed June, 2011.
Table 10 General Healthcare Applications

HCSIT URL50 [72] 2.0 (free) Palm OS, Windows An application to assist clinicians Includes Public Health Service guidelines on
Mobile with smoking cessation counseling smoking cessation; smoking cessation drug
of patients at the point of care. prescribing information; FTNDs questionnaire for
scoring nicotine dependence; recommend
pharmacotherapy for highly dependent smokers.
Borboleta URL51 1.0.2 (free) Palm OS, Symbian A mobile telehealth system for Registration of patient home visits; presents
[73] OS, Windows primary homecare. patient data, patient caregiver data, patient
Mobile, Android socioeconomic data, scheduled visits, new
visit registration, visit history of the patient,
disease catalog, and medication catalog.
LIFe-reader [52] Not Found Windows Mobile A smartphone-based CDSSt Scans EANu codes on drug packages; obtains
application with a barcode patient’s medication profile; checks for
reader designed for nurses in inappropriate drugs, drug-drug interactions,
geriatric homecare. therapeutic duplication, and warnings for
unsuitable drugs for elderly people.
Multimedia Prototype Web-enabled A real-time clinical alarm system Color-based severity indicator; displays the
Paging Based smartphone to monitor intensive care patients. alarms for an intensive care unit; displays vital
Clinical Alarm [75] signs at the moment of alarm; displays all
alarms for a patient bed.
Outbreaks 1.1 (free) iOS (iPhone, An application for real-time Displays outbreak location in Google map
Near Me URL52 [39] iPod Touch, iPad), disease outbreak information. and outbreak details from HealthMap database,
Android which utilizes medical email list services, news,
media report, official alerts, etc.
H1N1 Swine No longer iOS A newsreader application for News feed on H1N1 outbreak from CDCv,
Flu Update URL53 supported Swine Flu (H1N1) outbreaks. WHOw and major news organizations.
[39]
WISER URL54 [74] (free) Windows Mobile, An application for Emergency Provides access to NLM’s Hazardous Substances
Plam OS, iOS, Medical Service Specialists that Data Bank (HSDB); radiological and biological
BlackBerry, identifies chemical and substance report.
Android biological hazards on the basis
of symptoms and signs.
This table presents the version, platforms, a short description, and a list of functions of the seven general healthcare applications. These seven applications were
categorized as “general” since they do not fit into any of the categories from Tables 3 4, 5, 6, 7, 8 and 9.
s
FTND: Fagerstrom Test for Nicotine Dependence, tCDSS: Clinical Decision Support System, uEAN: European Article Number, vCDC: Center for Disease Control,
w
WHO: World Health Organization .
Website URLs:
URL50: http://www.smokefree.gov/software/Smartphone_Manual_Final.pdf, Accessed June, 2011.
URL51: http://ccsl.ime.usp.br/borboleta/, Accessed June, 2011.
URL52: http://healthmap.org/outbreaksnearme/, Accessed June, 2011.
URL53: http://www.qxmd.com/apps/h1n1-update, Accessed June, 2011.
URL54: http://wiser.nlm.nih.gov/, Accessed November, 2011.
Table 11 Medical Education Applications

I-Surgery 3.0 ($1.99) iOS, Android An application to keep a Stores data on surgeries including procedure,
Notebook URL55 log of surgical cases and pre-operative diagnosis, post-operative diagnosis,
[51] procedures. name of surgeons involved, and type of anesthesia
used; search case log.
Eponyms URL56 [51] 1.3.1 ($1.99, free iOS, Android Provides details of Includes eponym database from
student edition) eponymous signs and http://www.eponyms.net/; browse eponyms.
diseases.
Netter’s Atlas of ($76.95 – 1 year) Android, BlackBerry, A smartphone-based Contains more than 532 colored anatomic illustration,
Human Anatomy URL57 iOS, Palm OS, human anatomy tool radiographs, computed tomographic (CT) images, CT
[23,56] Windows Mobile for medical education angiograms, and MRIs; three dimensional images of
purposes. human body; separate groups of anatomic illustration,
i.e. head and neck, back and spinal cord, thorax,
abdomen, pelvis and perineum, upper and lower limb.
Netter’s Anatomy ($36.95 – 1 year) Android, BlackBerry, A mobile application Images with hot-spot help identifying parts of
Flash Cards URL58 iOS, Palm OS, containing about 300 anatomy easily; clinical notes, separate groups of
[51,56] Windows Mobile interactive flash cards. anatomic illustration, i.e. head and neck, back and
spinal cord, thorax, abdomen, pelvis and perineum,
upper and lower limb.
Table 11 Medical Education Applications (Continued)

Blausen Ear 2.11 ($2.99) iOS, Android, An application that Includes 6 video animations: cochlear implants, ear
Atlas URL59 [41] BlackBerry provides a set of ear- pressure, ear tubes, hearing loss, hearing test, otitis
related video animations. media.
Oxford Handbook 1.5 (£34.99 – UK only) iOS, BlackBerry Handheld version of the Includes twelve books, fully cross-referenced to the
of Clinical latest edition of Oxford Oxford Handbook of Clinical Medicine, practical
Specialties URL60 [41] Handbook of Clinical advice, cross-checked by authoritative subject
Specialties. experts, color illustrations and clinical photographs.
Dissection URL61 [41] 1.3 ($4.99) iOS A human anatomy This application displays human dissections; audio
application that mainly enabled annotations; tap-on identification feature;
focuses on head includes head, neck, and thorax.
and neck.
Cranial Nerves URL62 [41] 1.7 ($4.99) iOS A learning tool on cranial This application includes the cranial nerves and
nerves and skull base. skull base from high resolution CT scans; interactive
visualization; control the position and transparency
of the skull and each nerve along with the
appropriate textual information.
iSilo URL63 [17,47] 5.26 ($19.99) Palm OS, Windows A document reader Stores text in a highly compressed format;
Mobile, Symbian application on smartphone. password protected; categorization of documents;
OS, BlackBerry, iOS, search text within a document or set of documents;
Android copy and paste; navigation includes scrolling,
jumping, and marks; maximizing screen by hiding
scrollbar, title bar, toolbar, etc.; left-hand support;
remember last view location; remember jump
history for backtracking; local bookmarks.
Mobipocket (free) BlackBerry, An electronic book Customizable display; library view of all eBooks
Reader URL64 [11] Windows Mobile, reader on smartphone. stored in local media; annotate, highlight, bookmark
Symbian OS, any part of the eBook; search and lookup any word
Palm OS in the dictionary.
URL65
Instant ECG [23] 2.7 ($0.99) iOS A basic ECGj tutorial Includes ECGj electrophysiology, myocardial action
application. potential, associated waveforms, and intervals and
segments.
This table presents the version, platforms, a short description, and a list of functions of the eleven medical education applications for medical and nursing
students.
j
ECG: Electrocardiography.
Website URLs:
URL55: http://www.lifewareapps.com/index.php?option=com_content&view=article&id=49&Itemid=2, Accessed June, 2011.
URL56: http://code.google.com/p/eponyms-touch/, Accessed June, 2011.
URL57: http://www.skyscape.com/estore/ProductDetail_Netter5.aspx, Accessed June, 2011.
URL58: http://www.skyscape.com/estore/productdetail.aspx?ProductId=2833, Accessed June, 2011.
URL59: http://blausen.com/products, Accessed June, 2011.
URL60: http://www.medhand.com, Accessed June, 2011.
URL61: http://www.ehuman.com/products/bassett-dissection-iphone, Accessed June, 2011.
URL62: http://www.ehuman.com/products/cranial-nerves-iphone, Accessed June, 2011.
URL63: http://www.isilo.com/info/features.htm, Accessed June, 2011.
URL64: http://www.mobipocket.com/en/downloadsoft/productdetailsreader.asp, Accessed June, 2011.
URL65: http://www.instantecg.org/instant-ecg/, Accessed June, 2011.
Table 12 Applications for Patients

Diabeo URL66 [32] Beta Windows A telemedicine solution for diabetes Includes bolus calculators using validated
Mobile management. algorithms; takes into account carbohydrate
intake, pre-meal blood glucose, and anticipated
physical activity reported; plasma glucose targets;
automatic adjustments of carbohydrate ratio and
basal insulin; data transmission to medical staff
computers through GPRSx.
Cardiomobile URL67 Prototype Windows A real-time remote monitoring Sends ECGj rate, walking speed, heart rate, elapsed
[35] Mobile system for cardiac rehabilitation. distance and patient location to a secure server via
GPRSx during exercise sessions; server-side software
displays these data.
Pulmonary Prototype Windows An application based on standard Select and start exercise program; set custom
Rehabilitation [29] Mobile pulmonary rehabilitation program for personalized upper and lower heart rate; display
self-management, consists of Bluetooth heart rate, time remaining in seconds and
pulse oximeter and smartphone. feedback color (green: normal physical condition,
Table 12 Applications for Patients (Continued)

amber: normal condition but near acceptable
limits, red: dangerous physical condition).
PAL Calculator [82] Prototype Java-enabled Measures physical activity level (PAL) Displays questionnaire; measures PAL.
smartphones through questionnaire application on
smartphones.
Asthma Peak Flow Prototype Windows An application to monitor peak flow of Sends peak-flow reading through GPRSx network
Monitoring [79] Mobile asthma patients. to a secure server; receives asthma trend analysis
feedback from the server.
eCAALYX [83] Prototype Android A remote monitoring system for older Receives data from wearable health sensors in a
people with multiple chronic conditions. smart garment; transmits data to the monitoring
server; identifies higher-level information such as
tachycardia and signs of respiratory infections based
on established medical knowledge; displays most
recent medical details obtained from the sensors.
Hearing Check URL68 1.0 (free) iOS A simple and confidential hearing Calls a landline number to access a free
[86] check tool developed by RNIDy, UK hearing check.
uHear URL69 [41] 1.0 (Free) iOS A hearing loss self-assessment test. Three assessments: hearing sensitivity, speech
in noise, and a questionnaire about common
listening situations.
iTinnitus URL70 [41] 1.51 ($4.99) iOS A sound therapy package for patients Records tinnitus by frequency in Hertz and
with tinnitus. keeps track of the tinnitus in a daily diary graph,
supports full masking therapy that is some form
of sound played at a volume around the same
volume as the patient’s tinnitus, also supports
residual inhibition and habituation.
Sleep Aid URL71 [41] 1.3 ($2.99) iOS A sleep apnea management application. Records snoring; generates graph of snoring;
plays back snoring sound; provides information
about sleep apnea.
Fall Detector [78] Prototype Smartphone A fall detection system consisting of The embedded processor in the accelerometer
with camera tri-axial accelerometer with embedded process the data locally, sends data to the
support. processor and camera phone. camera phone through a Bluetooth connection
during a suspected fall; phone generates a
request to the user for vocal or keypad response;
automatically calls emergency services in serious
situations; sends data and video to emergency
services through high-speed 3G network.
Fall Detector [80] Prototype Wireless-enabled A fall detection application consisting Detects a fall; sends data to the server for
smartphone. of a smartphone with wireless Internet further analysis to determine an emergency.
connection, tri-axial accelerometer, and
microcontroller.
iFall [81] Prototype Android An application for fall detection Detects falls; determines false positives, request
and response. user’s attention by vibrating the phone, flashing
LEDs and screen, playing an audio message;
makes automatic emergency-services call.
Purdue Momentary 2.1.3 (free) Palm OS A human behavior monitoring tool. Event-driven study design; the application generate a
Assessment Tool URL72 beep when an event is fired; displays question sets,
[84,85,87] sets do-not-disturb time during busy moments.
Mayo Clinic 1.0 ($2.99) iOS An application that helps to practice Includes short training videos introducing key
Meditation URL73 [23] meditation. concepts; 15-minute meditation program and
5-minute meditation program.
This table presents the version, platforms, a short description, and a list of functions of the 15 applications for patients. Of these, six applications are for disease
management with chronic condition, four are ENT-related, three are fall-related, and two other conditions.
j
ECG: Electrocardiography, xGPRS: General Packet Radio Service, yRNID: Royal National Institute for Deaf People.
Website URLs:
URL66: http://www.diabeo.com/, Accessed June, 2011.
URL67: https://www.ihbi.qut.edu.au/about/researchover/injury/cardiomobile.jsp, Accessed June, 2011.
URL68: http://www.actiononhearingloss.org.uk/your-hearing/technology/equipment-and-research/iphone-hearing-check.aspx, Accessed June, 2011.
URL69: http://www.unitronhearing.com/unitron/global/en/professional/your_practice/uhear.html, Accessed June, 2011.
URL70: http://www.innerearsolutions.com/Software_Solutions.html, Accessed June, 2011.
URL71: http://www.remoteanalysis.net/sleepaid.html, Accessed June, 2011.
URL72: http://www.ruf.rice.edu/~dbeal/PMAT.html, Accessed June, 2011.
URL73: http://www.mremedy.com/Home_Products.php, Accessed June, 2011.
Competing interests 17. Serdar MA, Turan M, Cihan M: Rapid access to information resources in
The authors declare that they have no competing interests. clinical biochemistry: medical applications of Personal Digital Assistants
(PDA). Clinical and experimental medicine 2008, 8:117–122.
Authors' contributions 18. New Tool in the MD’s Bag: A Smartphone. [http://www.washingtonpost.com/
ASMM formulated the study design, performed literature search, screened wp-dyn/content/article/2009/05/18/AR2009051802234.html].
and reviewed the articles satisfying the eligibility criteria, collected data from 19. Knowledge on call: Physicians increasingly are discovering smartphones serve a
each eligible article and drafted the manuscript. IY participated in the study purpose beyond being a convenient communication gadget. [http://www.
design and helped draft the manuscript. LS helped draft the manuscript. All ama-assn.org/amednews/2009/01/05/plus/bisa0105.pdf].
authors read and approved the final manuscript. 20. Gamble K: Beyond phones. With the proper infrastructure, smartphones
can help improve clinician satisfaction and increase EMR use. Healthcare
Author details informatics: the business magazine for information and communication
1
University of Missouri Informatics Institute (MUII), 241 Engineering Building systems 2009, 26:23–24.
West, Columbia, MO 65211, USA. 2Health Management and Informatics (HMI) 21. M Brunberg: Opportunities and Challenges when Applying Mobile Technology
Department, University of Missouri School of Medicine, CS&E Bldg. DC006.00, in Health Care, Proceedings of Ume˚a’s 14th Student Conference in
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Received: 20 December 2011 Accepted: 14 June 2012 23. Sarasohn-Kahn J: How Smartphones Are Changing Health Care for Consumers
Published: 10 July 2012 and Providers. Oakland, CA: California HealthCare Foundation; 2010. http://
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BMC Medical Informatics and Decision Making 2012, 12:67

RESEARCH ARTICLE Open Access

A Systematic Review of Healthcare Applications

Background the literature according to their functionalities and

Table 2 Smartphone Operating-System Platforms, Features Support with Hardware

Smartphones platforms for. . .third-party applications. . ..having more

Symbian OS Tables 1 and 2 except recent apps, universal search

Windows Phone iOS

250,000 Google's Android Market

Android slower than Android’s (Figure 6). As seen in Figures 3, 4

Table 3 Disease Diagnosis Applications (Continued)

Table 3 Disease Diagnosis Applications (Continued)

Table 4 Drug Reference Applications

Table 4 Drug Reference Applications (Continued)

Table 5 Medical Calculator Applications

Table 5 Medical Calculator Applications (Continued)

Table 6 Literature Search Applications

Table 7 Clinical Communication Applications

Table 7 Clinical Communication Applications (Continued)

Table 8 HIS Client Applications

Table 9 Medical Training Applications

Table 10 General Healthcare Applications

Table 11 Medical Education Applications

Table 11 Medical Education Applications (Continued)

Table 12 Applications for Patients

Table 12 Applications for Patients (Continued)

139. Nokia’s new strategy: Windows Phone 7. [http://money.cnn.com/2011/02/11/

Submit your manuscript at

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